Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China

Clin Microbiol Infect. 2020 Jun;26(6):767-772. doi: 10.1016/j.cmi.2020.04.012. Epub 2020 Apr 15.

Abstract

Objective: In December 2019, coronavirus disease (COVID-19) emerged in Wuhan. However, the characteristics and risk factors associated with disease severity, unimprovement and mortality are unclear and our objective is to throw some light on these.

Methods: All consecutive patients diagnosed with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 11 to February 6, 2020, were enrolled in this retrospective cohort study.

Results: A total of 663 COVID-19 patients were included in this study. Among these, 247 (37.3%) had at least one kind of chronic disease; 0.5% of the patients (n = 3) were diagnosed with mild COVID-19, while 37.8% (251/663), 47.5% (315/663), and 14.2% (94/663) were in moderate, severe, and critical conditions, respectively. In our hospital, during follow-up 251 of 663 patients (37.9%) improved and 25 patients died, a mortality rate of 3.77%. Older patients (>60 years old) and those with chronic diseases were prone to have a severe to critical COVID-19 condition, to show unimprovement, and to die (p <0.001, <0.001). Multivariate logistic regression analysis identified being male (OR = 0.486, 95%CI 0.311-0.758; p 0.001), having a severe COVID-19 condition (OR = 0.129, 95%CI 0.082-0.201; p <0.001), expectoration (OR = 1.796, 95%CI 1.062-3.036; p 0.029), muscle ache (OR = 0.309, 95%CI 0.153-0.626; p 0.001), and decreased albumin (OR = 1.929, 95%CI 1.199-3.104; p 0.007) as being associated with unimprovement in COVID-19 patients.

Conclusion: Male sex, a severe COVID-19 condition, expectoration, muscle ache, and decreased albumin were independent risk factors which influence the improvement of COVID-19 patients.

Keywords: COVID-19; disease severity; mortality; patients; unimprovement.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Betacoronavirus
  • COVID-19
  • China / epidemiology
  • Chronic Disease
  • Coronavirus Infections / blood
  • Coronavirus Infections / complications
  • Coronavirus Infections / mortality*
  • Coronavirus Infections / therapy*
  • Disease Progression*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myalgia / virology
  • Pandemics
  • Patient Acuity*
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / mortality*
  • Pneumonia, Viral / therapy*
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Serum Albumin / metabolism
  • Sex Factors
  • Symptom Assessment
  • Treatment Failure
  • Young Adult

Substances

  • Serum Albumin