Factors significantly associated with COVID-19 severity in symptomatic patients: A retrospective single-center study

Abstract

Introduction The severity of coronavirus disease (COVID-19) in Japanese patients is unreported. We retrospectively examined significant factors associated with disease severity in symptomatic COVID-19 patients (COVID-Pts) admitted to our institution between February 20 and April 30, 2020. Methods All patients were diagnosed based on the genetic detection of severe acute respiratory syndrome coronavirus 2. Information on the initial symptoms, laboratory data, and computed tomography (CT) images at hospitalization were collected from the patients’ records. COVID-Pts were categorized as those with critical or severe illness (Pts-CSI) or those with moderate or mild illness (Pt-MMI). All statistical analyses were performed using R software. Results Data from 61 patients (16 Pt–CSI, 45 Pt-MMI), including 58 Japanese and three East Asians, were analyzed. Pt–CSI were significantly older and had hypertension or diabetes than Pt-MMI ( P < 0.001, 0.014 and < 0.001, respectively). Serum albumin levels were significantly lower in Pt–CSI than in Pt-MMI ( P < 0.001), whereas the neutrophil-to-lymphocyte ratio and C-reactive protein level were significantly higher in Pt–CSI than in Pt-MMI ( P < 0.001 and P < 0.001, respectively). In the CT images of 60 patients, bilateral lung lesions were more frequently observed in Pt–CSI than in Pt-MMI ( P = 0.013). Among the 16 Pt–CSI, 15 received antiviral therapy, 12 received tocilizumab, five underwent methylprednisolone treatment, six received mechanical ventilation, and one died. Conclusions The illness severity of Japanese COVID-Pts was associated with older age, hypertension and/or diabetes, low serum albumin, high neutrophil-to-lymphocyte ratio, and C-reactive protein.

Serum albumin concentrations are associated with disease severity and outcomes in coronavirus 19 disease (COVID-19): a systematic review and meta-analysis

“…Three studies were prospective [ 29 , 41 , 52 ], 51 retrospective [ 20 – 28 , 30 – 34 , 36 – 39 , 42 – 46 , 48 – 51 , 53 , 54 , 57 – 60 , 62 , 63 , 65 , 66 , 69 – 76 , 78 , 80 , 81 , 83 – 86 ], while 13 did not specifically declare the study design [ 23 , 35 , 40 , 47 , 55 , 56 , 61 , 64 , 67 , 68 , 77 , 79 , 82 ]. Fifty-two studies (77.6%) were performed in China [ 22 , 24 – 26 , 28 – 31 , 33 – 35 , 37 – 43 , 46 – 57 , 59 , 62 – 64 , 68 – 85 ] while the remaining 15 were conducted in the rest of the world [ 20 , 21 , 23 , 27 , 32 , 36 , 44 , 45 , 58 , 60 , 61 ...…”

“…Fifty-two studies (77.6%) were performed in China [ 22 , 24 – 26 , 28 – 31 , 33 – 35 , 37 – 43 , 46 – 57 , 59 , 62 – 64 , 68 – 85 ] while the remaining 15 were conducted in the rest of the world [ 20 , 21 , 23 , 27 , 32 , 36 , 44 , 45 , 58 , 60 , 61 , 65 – 67 , 86 ]. Endpoints included disease severity based on current clinical guidelines (31 studies, 46%) [ 22 , 24 , 28 , 32 , 33 , 35 , 36 , 38 , 39 , 44 – 47 , 49 – 52 , 54 , 56 , 58 , 64 , 66 , 69 , 72 , 73 , 75 , 77 , 79 , 81 – 83 ], survival (19 studies, 28%) [ 20 , 23 , 26 , 30 , 31 , 34 , 42 , 53 , 59 – 62 , 65 , …”

A meta-analysis: The mortality and severity of COVID-19 among patients with mental disorders

“…Several observational studies ( An et al, 2020 ; Batty et al, 2021 ; Cavallaro et al, 2020 ; Collaborative, 2021 ; Cummins et al, 2021 ; Fond et al, 2020 ; Giannoglou et al, 2020 ; Hirashima et al, 2021 ; Jeon et al, 2020 ; Lee et al, 2020a ; Lee et al, 2020b ; McKeigue et al, 2020 ; Nemani et al, January 2021 in JAMA psychiatry; Wang et al, 2020 ; Yang et al, 2020 ; Yanover et al, 2020 ) investigated whether people with mental disorders have poorer COVID-19 outcomes or not, thus we have decided to conduct this meta-analysis that aims to investigate the relationship between pre diagnosed psychiatric illness and COVID-19 mortality and severity suggesting that people with mental disorders might have worse outcome of COVID-19.…”

Immune Response to SARS-CoV-2 Infection in Obesity and T2D: Literature Review

“…A similar retrospective study in Japan by Hirashima, T., et al reported a significant correlation between hypertension, older age, diabetes, and disease severity. The critical group exhibited higher levels of CRP than the moderate group [ 185 ]. Consistently, a Spanish retrospective study, showed that IL-6, ferritin, D-dimer, and CRP levels were higher as disease severity increased [ 186 ].…”

“…By extracting clinical summarized data, various studies showed significant evidence of a systemic reduction in T-cell populations (lymphocytopenia) in obese/T2D patients as COVID-19 progressed [ 134 , 155 , 156 , 158 , 162 , 163 , 164 , 170 ]. Importantly, patients hospitalized with underlying conditions presented worse lymphocytopenia than those who did not report comorbidities [ 178 , 185 , 186 , 187 , 189 ]. Based on this information, the majority of the researchers have proposed that lymphocytopenia could potentially be used as an indicator of COVID-19 severity [ 190 , 191 , 192 ].…”