Moderate COVID-19: Clinical Trajectories and Predictors of Progression and Outcomes

Abstract

Background: Patients with COVID-19 commonly present at healthcare facilities with moderate disease, i.e., pneumonia without a need for oxygen therapy. Aim: To identify clinical/laboratory characteristics of patients with moderate COVID-19, which could predict disease progression. Methods: 384 adult patients presented with moderate COVID-19 and admitted to two hospitals were retrospectively evaluated. In a multivariate analysis gender, age, BMI, Charlson Comorbidity Index (CCI) and National Early Weaning Score 2 were treated as co-variates. The development of hypoxemic respiratory failure, intubation rate and risk of death were considered as dependent variables. Estimated values are presented as odds-ratio (OR) with 95% confidence interval (CI). Results: Most of the patients were male (63.28%) with a mean (standard deviation) age of 59 (16.04) years. Median (interquartile range) CCI was 2 (1–4). A total of 58.85% of the patients developed respiratory failure; 6.51% were intubated, and 8.85% died. The extent of pneumonia in chest X-ray (involvement of all four quartiles) [OR 3.96 (1.18–13.27), p = 0.026], respiratory rate [OR 1.17 (1.05–1.3), p = 0.004], SatO2 [OR 0.72 (0.58–0.88), p = 0.002], systolic blood pressure [OR 1.02 (1–1.04), p = 0.041] and lymphocyte count [OR 0.9993 (0.9986–0.9999), p = 0.026] at presentation were associated with the development of respiratory failure. The extent of pneumonia [OR 26.49 (1.81–387.18), p = 0.017] was associated with intubation risk. Age [OR 1.14 (1.03–1.26), p = 0.014] and the extent of pneumonia [OR 22.47 (1.59–316.97), p = 0.021] were associated with increased risk of death. Conclusion: Older age, the extent of pneumonia, tachypnea, lower SatO2, higher systolic blood pressure and lymphopenia are associated with dismal outcomes in patients presenting with moderate COVID-19.

Novel Risks of Unfavorable Corticosteroid Response in Patients with Mild-to-Moderate COVID-19 Identified Using Artificial Intelligence-Assisted Analysis of Chest Radiographs

“…Since consolidation is a frequently observed finding in COVID-19-associated pneumonia, typically appearing around 6–7 days after the onset of symptoms, it is understandable that there is an association between the consolidation score within 10 days after the onset of symptoms and the treatment outcome [ 36 ]. This is also consistent with the recent report of an association of between the extent of pneumonia in CXR and poor outcomes [ 13 ]. Notably, the gap in pleural effusion score widened approximately a week after symptom onset, when viral replication usually phases out with hyper-immune activation phasing in.…”

“…The pathophysiologic mechanism of tissue tropism of SARS-CoV-2 through angiotensin-converting enzyme 2 receptor, which damages alveolar epithelial and capillary endothelial cells by an immune reaction, suggests that imaging modality could be used to predict the prognosis of COVID-19 patients [ 11 , 12 , 13 ]. A study by Liang et al highlighted the utility of a scoring system that includes a chest radiograph (CXR) as a factor to predict the prognosis of COVID-19 patients [ 14 ], while D’Cruz et al presented opposing views regarding its role [ 15 ].…”

Novel Risks of Unfavorable Corticosteroid Response in Patients with COVID-19 Identified by Artificial Intelligence-Assisted Analysis of Chest Radiographs

“…Since consolidation is a frequently observed finding in COVID-19associated pneumonia, typically appearing around 6-7 days after the onset of symptoms, it is understandable that there is an association between the consolidation score within 10 days after the onset of symptoms and the treatment outcome [36]. This is also consistent with the recent report of an association of between the extent of pneumonia in CXR and poor outcomes [13]. Notably, the gap in pleural effusion score widened approximately a week after symptom onset, when viral replication usually phases out with hyper-immune activation phasing in.…”

“…The pathophysiologic mechanism of tissue tropism of SARS-CoV-2 through angiotensinconverting enzyme 2 receptor, which damages alveolar epithelial and capillary endothelial cells by an immune reaction, suggests that imaging modality could be used to predict the prognosis of COVID-19 patients [11][12][13]. A study by Liang et al highlighted the utility of a scoring system that includes a chest radiograph (CXR) as a factor to predict the prognosis of COVID-19 patients [14], while D'Cruz et al presented opposing views regarding its role [15].…”

Kinetics of Immune Subsets in COVID-19 Patients Treated with Corticosteroids

“…Lymphopenia is a hallmark of severe and critical COVID-19 [ 20 , 21 , 22 , 23 ] and is a predictor of upcoming respiratory failure in patients with SARS-CoV-2-related pneumonia [ 24 ]. In line with these observations, we here demonstrated that patients with severe COVID-19 had significantly fewer T- and B-lymphocytes compared to those with pneumonia and no respiratory failure and that the profile of lymphocyte subtypes was similar between patients who recovered after the administration of dexamethasone and those who progressed to intubation and/or death.…”