Risk factors for developing into critical COVID-19 patients in Wuhan, China: A multicenter, retrospective, cohort study

Abstract

Background The ferocious global assault of COVID-19 continues. Critically ill patients witnessed significantly higher mortality than severe and moderate ones. Herein, we aim to comprehensively delineate clinical features of COVID-19 and explore risk factors of developing critical disease. Methods This is a Mini-national multicenter, retrospective, cohort study involving 2,387 consecutive COVID-19 inpatients that underwent discharge or death between January 27 and March 21, 2020. After quality control, 2,044 COVID-19 inpatients were enrolled. Electronic medical records were collected to identify the risk factors of developing critical COVID-19. Findings The severity of COVID-19 climbed up straightly with age. Critical group was characterized by higher proportion of dyspnea, systemic organ damage, and long-lasting inflammatory storm. All-cause mortality of critical group was 85•45%, by contrast with 0•58% for severe group and 0•18% for moderate group. Logistic regression revealed that sex was an effect modifier for hypertension and coronary heart disease (CHD), where hypertension and CHD were risk factors solely in males. Multivariable regression showed increasing odds of critical illness associated with hypertension, CHD, tumor, and age ≥ 60 years for male, and chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), tumor, and age ≥ 60 years for female. Interpretation We provide comprehensive front-line information about different severity of COVID-19 and insights into different risk factors associated with critical COVID-19 between sexes. These results highlight the significance of dividing risk factors between sexes in clinical and epidemiologic works of COVID-19, and perhaps other coronavirus appearing in future. Funding .

Aging- and gender-related modulation of RAAS: potential implications in COVID-19 disease

“…As discussed previously, recent epidemiologic data show that the severity and mortality of COVID-19 infection increase as a function of age, with a steep increase in patients older than 60 years; further, COVID-19 infection is more likely to be severe and lethal in men than women ( 2 , 4 , 7 , 8 , 9 ). These age and gender effects occur independently of comorbidities making aging and male gender independent risk factors for severe COVID-19 infection ( 10 , 11 , 12 , 13 ). In light of the key role of RAAS in the response to COVID-19 infection, here we will review the effect of aging and gender on key elements of the RAAS cascade with emphasis on ACE2 and on the balance between the Ang II/AT1R and Ang(1–7)/MasR axes.…”

“…The mechanisms responsible for the effects of aging and male gender, as independent risk factors ( 11 , 12 , 13 ), on morbidity and mortality of COVID-19 disease are still unknown. However, the renin-angiotensin-aldosterone system (RAAS) is strictly involved in COVID-19 and may play a role in aging- and gender-related differences in the severity of the infection.…”

Nutritional Risk Screening and Body Composition in COVID‐19 Patients Hospitalized in an Internal Medicine Ward

“…4,9 Currently, several studies are striving to define the risk factors for the development of severe pneumonia in COVID-19 patients and to identify the factors that can have an impact on patient outcome. 10,11 To date, there are also no studies that have evaluated the nutritional status of patients affected by COVID-19 with bioelectrical impedance analysis (BIA). Given the prognostic value of bioimpedance parameters on different clinical outcomes already demonstrated for other categories of patients, 11,12 it can be assumed that this could also provide useful information in the management of COVID-19 patients.…”

Early triage of patients diagnosed with COVID-19 based on predicted prognosis: A Korean national cohort study

“…The predictors chosen in this study are not much different from the known risk factors of developing into critical conditions from COVID-19 19 . However, it was unexpected that COPD, a known strong risk factor, was not selected as a predictor.…”

“…Since the World Health Organization (WHO) declared the coronavirus disease 2019 (COVID- 19) a pandemic in March 2020, it has been raging on, taking the lives of many people (over 1.32 million as of November 17, 2020) 1 . However, since no effective anti-viral drug or vaccine has been developed yet, the treatment mainly relies on symptomatic relief and supportive care, oxygen therapy, and critical care, depending on the disease severity.…”