Patterns of Deterioration in Moderate Patients With COVID-19 From Jan 2020 to Mar 2020: A Multi-Center, Retrospective Cohort Study in China

Abstract

Background: Around the globe, moderate cases account for the largest proportion of all coronavirus disease 2019 (COVID-19) patients, and deteriorated moderate patients contribute the most in mortality. However, published articles failed to address the deterioration details of moderate cases, especially on when and how they deteriorated.Methods: All moderate COVID-19 patients hospitalized in Guangdong Province from January 14 to March 16, 2020, were included in this multicenter retrospective cohort study and were divided into deteriorated and non-deteriorated groups according to clinical status. Symptoms and demographic, therapeutic, and laboratory test result characteristics were collected to explore the features of disease deterioration.Results: Of 1,168 moderate patients included, 148 (13%) deteriorated to severe (130 cases) or critical (18 cases) status. Over 20% of the older subgroup (>50 years old) showed deterioration. The median time for deterioration was 11 days after onset [interquartile range (IQR) 9–14 days]. In addition, 12.2% severe cases could further develop to critical status after 3 days (IQR 2–6.5 days) of having a severe condition. Respiratory dysfunction and hypoxia were the major manifestations as disease deterioration, while 76 cases (52.1%) showed respiratory rate >30 breaths/min, 119 cases (80.4%) showed SaO2 <93%, 100 cases (67.5%) had 201 < PaO2/FiO2 < 300, and 27 cases (18.9%) had blood lactic acid >2.0 mmol/L. In view of multiple organ dysfunction, 87.8% of acute respiratory distress syndrome (ARDS), 20.2% of acute kidney injury (AKI), 6.8% of coagulopathy, 4% of acute heart failure (AHF), 3.4% of acute hepatic injury (AHI), and 5.4% of shock occurred in deteriorated patients, while organ injury occurred in the following sequence: ARDS, AKI, AHF, coagulopathy, AHI, and shock.Conclusions: The deteriorated pattern of moderate COVID-19 patients is characterized as the 11th day from onset (IQR 9–14 days) being an important time point of disease deterioration with further exacerbation to critical condition in 3 days (IQR 2–6.5 days), A RDS followed by AKI being the typical modes of sequential organ damage.

Beware of pharyngeal Fusobacterium nucleatum in COVID-19

“…For the healthy individuals who contributed pharyngeal swab samples, the median age was 43.5 years (interquartile range [IQR]: 31.5 ~ 47.5), with a male:female sex ratio of 1; the healthy fecal donors’ median age was 31.0 years (IQR: 28.0 ~ 44.0), with a male:female sex ratio of 0.8. Moderate illness accounted for the largest proportion of all the enrolled cases (66.67% ~ 70.43%), which was consistent with actually observed tendency [ 42 , 43 ]. Asymptomatic infection, mild and severe ilness were less than 5% each.…”

“…Data including age, sex, disease severity, the date of symptom onset (the day when the symptom was noticed), the sampling day and sampling intervals of the confirmed patients were registered (Table 1 , Supplementary Tables 1 – 2 ). Indeed, retrospective cohort studies indicate that clinical course provides an objective basis for the egregation of patients into groups, and 7 days is an time node of great clinical importance [ 5 , 43 , 44 ]. Although we intended to group the samples by the sampling intervals (intervals from symptom onset to the sampling time) as ≤7 d, 7–14 d and > 14 d, the numbers of pharyngeal swab samples in the latter two groups were too small ( n = 3 and 1, respectively) for a proper statistical analysis.…”

Prognostic value of inflammatory markers in patients with COVID-19 in Indonesia

“…Only COVID-19 patients with mild and moderate cases classified as non-severe cases and treated in a regular isolation ward on hospital admission were included in this study. Since previous studies have described the median time for COVID-19 clinical deterioration was 9–11 days after onset illness, 8 , 9 , 10 we excluded patients with early admission (<48 h) to ICU since they were more likely to already be in a severe or critically ill condition, which may confound the analyses results.…”

Interleukin-6 receptor blockade in patients with COVID-19: placing clinical trials into context

“…Clinicians caring for hospitalised patients with severe COVID-19-related hypoxaemic respiratory failure often look retrospectively at two important time intervals: first, the time from onset of symptoms; and second, the time since clinical deterioration. 34 , 35 Although viral replication probably peaks earlier, the peak of the inflammatory response to SARS-CoV-2 often coincides with or shortly precedes clinical deterioration. 36 Once the inflammatory cascade achieves a state of hyperactivation, it might be too late to intervene, and it has therefore been hypothesised that a time window exists within which therapies targeting the inflammatory response (eg, IL-6 inhibitors) will be most beneficial.…”