Evaluation of the Risk of Clinical Deterioration among Inpatients with COVID-19

Abstract

This study aims to assess the risk of severe forms of COVID-19, based on clinical, laboratory, and imaging markers in patients initially admitted to the ward. This is a retrospective observational study, with data from electronic medical records of inpatients, with laboratory confirmation of COVID-19, between March and September 2020, in a hospital from Juiz de Fora-MG, Brazil. Participants (n = 74) were separated into two groups by clinical evolution: those who remained in the ward and those who progressed to the ICU. Mann–Whitney U test was taken for continuous variables and the chi-square test or Fisher’s exact test for categorical variables. Comparing the proposed groups, lower values of lymphocytes ( p = <0.001) and increases in serum creatinine ( p = 0.009), LDH ( p = 0.057), troponin ( p = 0.018), IL-6 ( p = 0.053), complement C4 ( p = 0.040), and CRP ( p = 0.053) showed significant differences or statistical tendency for clinical deterioration. The average age of the groups was 47.9 ± 16.5 and 66.5 ± 7.3 years ( p = 0.001). Hypertension ( p = 0.064), heart disease ( p = 0.048), and COPD ( p = 0.039) were more linked to ICU admission, as well as the presence of tachypnea on admission ( p = 0.051). Ground-glass involvement >25% of the lung parenchyma or pleural effusion on chest CT showed association with evolution to ICU ( p = 0.027), as well as bilateral opacifications ( p = 0.030) when compared to unilateral ones. Laboratory, clinical, and imaging markers may have significant relation with worse outcomes and the need for intensive treatment, being helpful as predictive factors.

Multicenter validation of Early Warning Scores for detection of clinical deterioration in COVID-19 hospitalized patients

“…These observations are interesting and have been reported by other authors. 8 , 15 This may indicate that the effect of pre-existing health conditions could be manifest in other variables of the score such as laboratory results or physiological markers. By analyzing vital signs and laboratory tests results 24 h prior to ICU admission, we observed a significant reduction in Sp02 and need of supplemental oxygen.…”

Risk Assessment of COVID-19 Cases in Emergency Departments and Clinics With the Use of Real-World Data and Artificial Intelligence: Observational Study

“…Several attempts to develop solutions that accurately predict deterioration among patients with COVID-19 at various levels have been made since the beginning of the pandemic. An observational cohort study developed in Brazil [ 16 ] attempted to evaluate the risk of severe forms of COVID-19, based on clinical, laboratory, and imaging markers in patients initially admitted to the ward. The data they used were acquired from the electronic medical records of inpatients, with laboratory confirmation of COVID-19.…”

The impact of the secondary infections in ICU patients affected by COVID-19 during three different phases of the SARS-CoV-2 pandemic

“…Inflammatory chemical biomarkers and proper microbiological surveillance may be fundamental for the management of COVID-19 patients because they allow the early detection of markers which correlate with the presence of such infections and a negative outcome. Laboratory data are thus fundamental to support clinicians in monitoring the hospitalized patients and follow the clinical evolution of COVID-19 [ 17 ].…”