Analysis of clinical features and early warning signs in patients with severe COVID-19: a retrospectivecohort study v1

• DOI: 10.17504/protocols.io.bfpejmje
• Publication Date: 2020-05-22T03:09:31Z
• Authors: Xinpei Yue; Xinkui Liu

The Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China during December of 2019. Previous studies have described clinical aspectsof the COVID-19 illness;however, insufficient literature currently exists regarding detecting severe conditions in patients during the early diagnosisstage. Patients admitted to a designated hospital in the Henan Province of China with outcomes of either discharge or death before February 15, 2020 were enrolled retrospectively as a cohort study population. Patients who underwent at least one of the following treatments were considered a severe group: continuous renal replacement therapy (CRRT), high-flow oxygen absorption, noninvasive and invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO); while,the remaining patients were considereda non-severe group. Data regarding basic information, initial symptoms, and first visit examination results were collected from electronic medical records (EMR) and compared between the severe and non-severe groups. Multivariate logistic regression analysis was performed to determine predictors. Areceiver operating characteristic (ROC) curve was applied to find threshold for each predictor. Altogether,104 patients were enrolled to our study with 30 and 74 patients in the severe and non-severe groups, respectively. A majority of older patients werein the severe group. In addition,patients in the severe group had higher direct bilirubin, lactate dehydrogenase, C-reactive protein (CRP), and procalcitonin along witha lower absolute lymphocyte value. Multivariate logistic analysis indicated that patients aged ≥63-years (odds ratio 41.0, 95% CI 2.8~592.4)，with an absolute lymphocyte value≤1.02×10^9/L (odds ratio 6.1, 95% CI 1.5~25.2), CRP≥65.08mg/L (odds ratio8.9, 95% CI 1.0~74.2) had more risk being diagnosed as severe condition.