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Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities
BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic continues to escalate intensively worldwide. Massive studies on general populations with SARS-CoV-2 infection have revealed that pre-existing comorbidities were a major risk factor for the poor prognosis of COVID-19. Notably, 49–75% of COVID-1...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8598256/ https://www.ncbi.nlm.nih.gov/pubmed/34861603 http://dx.doi.org/10.1016/j.jiph.2021.11.012 |
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author | Liu, Weifang Yang, Chengzhang Liao, Yuan-gao Wan, Feng Lin, Lijin Huang, Xuewei Zhang, Bing-Hong Yuan, Yufeng Zhang, Peng Zhang, Xiao-Jing She, Zhi-Gang Wang, Lei Li, Hongliang |
author_facet | Liu, Weifang Yang, Chengzhang Liao, Yuan-gao Wan, Feng Lin, Lijin Huang, Xuewei Zhang, Bing-Hong Yuan, Yufeng Zhang, Peng Zhang, Xiao-Jing She, Zhi-Gang Wang, Lei Li, Hongliang |
author_sort | Liu, Weifang |
collection | PubMed |
description | BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic continues to escalate intensively worldwide. Massive studies on general populations with SARS-CoV-2 infection have revealed that pre-existing comorbidities were a major risk factor for the poor prognosis of COVID-19. Notably, 49–75% of COVID-19 patients had no comorbidities, but this cohort would also progress to severe COVID-19 or even death. However, risk factors contributing to disease progression and death in patients without chronic comorbidities are largely unknown; thus, specific clinical interventions for those patients are challenging. METHODS: A multicenter, retrospective study based on 4806 COVID-19 patients without chronic comorbidities was performed to identify potential risk factors contributing to COVID-19 progression and death using LASSO and a stepwise logistic regression model. RESULTS: Among 4806 patients without pre-existing comorbidities, the proportions with severe progression and mortality were 34.29% and 2.10%, respectively. The median age was 47.00 years [interquartile range, 36.00–56.00], and 2162 (44.99%) were men. Among 51 clinical parameters on admission, age ≥ 47, oxygen saturation < 95%, increased lactate dehydrogenase, neutrophil count, direct bilirubin, creatine phosphokinase, blood urea nitrogen levels, dyspnea, increased blood glucose and prothrombin time levels were associated with COVID-19 mortality in the entire cohort. Of the 3647 patients diagnosed with non-severe COVID-19 on admission, 489(13.41%) progressed to severe disease. The risk factors associated with COVID-19 progression from non-severe to severe illness were increased procalcitonin levels, SpO2 < 95%, age ≥ 47, increased LDH, activated partial thromboplastin time levels, decreased high-density lipoprotein cholesterol levels, dyspnea and increased D-dimer levels. CONCLUSIONS: COVID-19 patients without pre-existing chronic comorbidities have specific traits and disease patterns. COVID-19 accompanied by severe bacterial infections, as indicated by increased procalcitonin levels, was highly associated with disease progression from non-severe to severe. Aging, impaired respiratory function, coagulation dysfunction, tissue injury, and lipid metabolism dysregulation were also associated with disease progression. Once factors for multi-organ damage were elevated and glucose increased at admission, these findings indicated a higher risk for mortality. This study provides information that helps to predict COVID-19 prognosis specifically in patients without chronic comorbidities. |
format | Online Article Text |
id | pubmed-8598256 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. |
record_format | MEDLINE/PubMed |
spelling | pubmed-85982562021-11-18 Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities Liu, Weifang Yang, Chengzhang Liao, Yuan-gao Wan, Feng Lin, Lijin Huang, Xuewei Zhang, Bing-Hong Yuan, Yufeng Zhang, Peng Zhang, Xiao-Jing She, Zhi-Gang Wang, Lei Li, Hongliang J Infect Public Health Original Article BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic continues to escalate intensively worldwide. Massive studies on general populations with SARS-CoV-2 infection have revealed that pre-existing comorbidities were a major risk factor for the poor prognosis of COVID-19. Notably, 49–75% of COVID-19 patients had no comorbidities, but this cohort would also progress to severe COVID-19 or even death. However, risk factors contributing to disease progression and death in patients without chronic comorbidities are largely unknown; thus, specific clinical interventions for those patients are challenging. METHODS: A multicenter, retrospective study based on 4806 COVID-19 patients without chronic comorbidities was performed to identify potential risk factors contributing to COVID-19 progression and death using LASSO and a stepwise logistic regression model. RESULTS: Among 4806 patients without pre-existing comorbidities, the proportions with severe progression and mortality were 34.29% and 2.10%, respectively. The median age was 47.00 years [interquartile range, 36.00–56.00], and 2162 (44.99%) were men. Among 51 clinical parameters on admission, age ≥ 47, oxygen saturation < 95%, increased lactate dehydrogenase, neutrophil count, direct bilirubin, creatine phosphokinase, blood urea nitrogen levels, dyspnea, increased blood glucose and prothrombin time levels were associated with COVID-19 mortality in the entire cohort. Of the 3647 patients diagnosed with non-severe COVID-19 on admission, 489(13.41%) progressed to severe disease. The risk factors associated with COVID-19 progression from non-severe to severe illness were increased procalcitonin levels, SpO2 < 95%, age ≥ 47, increased LDH, activated partial thromboplastin time levels, decreased high-density lipoprotein cholesterol levels, dyspnea and increased D-dimer levels. CONCLUSIONS: COVID-19 patients without pre-existing chronic comorbidities have specific traits and disease patterns. COVID-19 accompanied by severe bacterial infections, as indicated by increased procalcitonin levels, was highly associated with disease progression from non-severe to severe. Aging, impaired respiratory function, coagulation dysfunction, tissue injury, and lipid metabolism dysregulation were also associated with disease progression. Once factors for multi-organ damage were elevated and glucose increased at admission, these findings indicated a higher risk for mortality. This study provides information that helps to predict COVID-19 prognosis specifically in patients without chronic comorbidities. The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. 2022-01 2021-11-18 /pmc/articles/PMC8598256/ /pubmed/34861603 http://dx.doi.org/10.1016/j.jiph.2021.11.012 Text en © 2021 The Author(s) Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Original Article Liu, Weifang Yang, Chengzhang Liao, Yuan-gao Wan, Feng Lin, Lijin Huang, Xuewei Zhang, Bing-Hong Yuan, Yufeng Zhang, Peng Zhang, Xiao-Jing She, Zhi-Gang Wang, Lei Li, Hongliang Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities |
title | Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities |
title_full | Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities |
title_fullStr | Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities |
title_full_unstemmed | Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities |
title_short | Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities |
title_sort | risk factors for covid-19 progression and mortality in hospitalized patients without pre-existing comorbidities |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8598256/ https://www.ncbi.nlm.nih.gov/pubmed/34861603 http://dx.doi.org/10.1016/j.jiph.2021.11.012 |
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