Clinical Features and Risk Factors for the Severity of Inpatients with COVID-19: A Retrospective Cohort Study

Background: Coronavirus disease 2019 (COVID-19) have become a pandemic in the world since it was found and caused an outbreak on December, 2019, Wuhan, China, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical features of patients with COVID-19 have been investigated but risk factors for disease severity in the early stage have not been well described. Methods: In this retrospective cohort study, we included in-hospital patients with laboratory confirmed COVID-19 from the Fifth Affiliated Hospital of Sun Yat-Sen University (Zhuhai, China) who had been discharged by Mar 9, 2020. Demographic, clinical, treatment, and laboratory data extracted from electronic medical records and dynamic change of biochemical indicators in hospital were compared between common and severe type patients. Univariable and multivariable logistic regression methods were used to explore the risk factors associated with the severity of COVID-19. Findings: 52 patients were included in this study, of whom 22 were severe type and 30 for common type. 30 (57.7%) patients had a comorbidity, with hypertension being the most common (12 [23.1%] patients), followed by diabetes (6 [11.5%] patients) and cardiovascular disease (3 [5.8%] patients). Multivariable regression demonstrated increasing odds of severity associated with the duration of fever (odds ratio 1.22, 95% CI 1.051–1.416, per day increase; p=0·009), CRP (1.061, 95% CI 1.009-1.116; p=0.02), and oxygen partial pressure less than 80 mmHg (8.034, 95% CI 1.216–53.082; p=0·031) on admission. Lymphocyte, lymphocyte percentage, and platelet within 20 days of illness onset were lower in the severe patients compared with common patients, red blood cell and hemoglobin from illness onset decreased but eosinophils increased gradually in COVID-19 patients. Additionally, elevated levels of AST, bilirubin, NT-proBNP, D-dimer, CK, and lactate dehydrogenase were more commonly observed in severe COVID-19 patients. Interpretation: The potential risk factors of the duration of fever, CRP and oxygen partial pressure less than 80 mmHg could benefit for clinicians to evaluate the severity of patients with COVID-19 at an early stage and provide a reference for evaluating therapeutic effect. Funding Statement: This study received the following funding: the National Science Foundation for Young Scientists of China (Grant No· 81900568/ H0318). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by the Research Ethics Commission of the Fifth Affiliated Hospital of Sun Yat-Sen University (No·ZDWY[2020] Lunzi No·(K22-1)).