Objective: To identify the risk factors for predicting the dynamic progression of COVID-19.
Methods: A total of 2321 eligible patients were included in this study from February 4 to April 15, 2020. Two illness conditions, including mild/moderate (M/M) subtype to severe/critical (S/C) and S/C to fatality, were classified. Clinical message was collected and compared, respectively. Kaplan–Meier method, Cox regression model and risk score system were used to predict disease progression in S/C COVID-19.
Results: A total of 112 of 1761 patients with M/M subtype were progressors (P) and 1649 non-progressors (NP). Increasing disease progression associated with higher levels of neutrophils count (HR=1.958, 95% CI=1.253– 3.059, P =0.003), CK (HR=2.203, 95% CI=1.048– 4.632, P =0.037), LDH (HR=3.309, 95% CI=2.083– 5.256, P < 0.001) and CRP (HR=2.575, 95% CI=1.638– 4.049, P < 0.001), and lower level of lymphocytes count (HR=1.549, 95% CI=1.018– 2.355, P =0.041), as well as total lesion volume ratio greater than ≥ 10% (HR=2.286, 95% CI=1.451– 3.601, P < 0.001) on admission. In progression to fatality, 56 of the 672 S/C cases died and 616 survived. Increasing fatality associated with lower level of lymphocytes count (HR:2.060, 95% CI:1.000– 4.242, P =0.050), higher levels of BUN (HR:2.715, 95% CI:1.539– 4.790, P < 0.001), CK-MB (HR:3.412, 95% CI:1.760– 6.616, P < 0.001), LDH (HR:5.578, 95% CI:2.317– 13.427, P < 0.001), and PT (HR:3.619, 95% CI:2.102– 6.231, P < 0.001). Furthermore, high risk of neutrophils count, lymphocytes count, CK, LDH, CRP, and total lesion volume ratio was powerfully correlated with the incidence of progression to S/C in patients with NS COVID-19 and high odds of lymphocytes count, BUN, CK-MB, LDH, and PT were significantly associated with death in patients with S/C COVID-19. In addition, the progression and mortality rates increased with increasing risk scores.
Conclusion: Elevated LDH level and lymphopenia were independent predictors for COVID-19 sustainable management in classifying non-severe patients who progressed to severe condition and identifying S/C patients who deteriorated to fatal outcomes as well. Total lesion volume ratio ≥ 10% may provide early predictive evidence with COVID-19 patients at high risk of developing into S/C to improve prognosis.
Keywords: COVID-19, mild/moderate, severe/critical, progression, fatality, risk factors