A multicenter, retrospective study from China published in the Journal of Infection and Public Health has identified risk factors for progression of Covid-19 and mortality in hospitalized patients who had no comorbid conditions.¹

The study was conducted in 21 hospitals in Hubei Province, China and involved 4806 patients, aged 47 years (median) with no comorbid conditions at baseline. Around 45% of the subjects were men. Diagnosis of Covid-19 was based on either RT PCR and/or CT manifestations. The severity of disease was categorized as mild, moderate severe, and critical. Patients with mild and moderate illnesses were considered as non-severe, while those with severe and critical conditions were classified as having severe illness. The duration from onset of symptoms to hospital admission was 10 days (average), while the duration from onset of symptoms to either discharge or death was 32 days (average). Fever was the most common presenting symptom, reported by 75.38%. The most prevalent radiologic findings were bilateral lesions (81.48%) and ground-glass opacities (52.70%). There were 100 deaths in the study group. Out of a total of 3647 patients with non-severe Covid-19 at the time of hospitalization, 489 (13.41%) patients progressed to severe disease.

Among the patients admitted with severe illness, nine risk factors were identified to have high correlation with progression to death during hospitalization. These risk factors included age ≥ 47 years, SpO2 < 95%, increased levels of creatine phosphokinase, decreased albumin levels, neutrophilia, hyperglycemia, increased direct bilirubin, BUN levels and dyspnea. Among these, patients aged older than 55 years (OR 14.15) and SpO2 < 95% (OR 7.13) were at the highest risk of death.

Similarly, eight risk factors were found to be associated with progression of Covid-19 from non-severe to severe illness during hospital stay. These risk factors were raised procalcitonin levels, SpO2, age ≥ 47 years, increased lactate dehydrogenase (LDH), activated partial thromboplastin time (APTT) levels, reduced high-density lipoprotein cholesterol (HDL-c) levels, dyspnea and increased D-dimer.

Patients with severe illness and among those that succumbed to their illness had a higher likelihood of developing acute respiratory distress syndrome (ARDS), septic shock and multiorgan damage.

These findings will aid clinicians in the identification of their patients who do not have any underlying chronic medical condition but are likely to progress to severe disease. Early and timely intervention will improve patient prognosis and reduce chances of Covid-related death.

Reference

1. Liu W, et al. Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities. J Infect Public Health. 2021 Nov 18;15(1):13-20. doi: 10.1016/j.jiph.2021.11.012.