Virologic and clinical characteristics for prognosis of severe COVID-19: a retrospective observational study in Wuhan, China

Abstract

Background:The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has progressed to a pandemic associated with substantial morbidity and mortality. The WHO and the United States Center for Disease Control and Prevention (CDC) have issued interim clinical guidance for management of patients with confirmed coronavirus disease (COVID-19), but there is limited data on the virologic and clinical characteristics for prognosis of severe COVID-19. Methods:A total of 50 patients with severe COVID-19 were divided into good and poor recovery groups. The dynamic viral shedding and serological characteristics of SARS-CoV-2 were explored. The risk factors associated with poor recovery and lung lesion resolutions were identified. In addition, the potential relationships among the viral shedding, the pro-inflammatory response, and lung lesion evolutions were characterized. Results:A total of 58% of the patients had poor recovery and were more likely to have a prolonged interval of viral shedding. The longest viral shedding was 57 days after symptom onset. Older age, hyperlipemia, hypoproteinemia, corticosteroid therapy, consolidation on chest computed-tomography (CT), and prolonged SARS-CoV-2 IgM positive were all associated with poor recovery. Additionally, the odds of impaired lung lesion resolutions were higher in patients with hypoproteinemia, hyperlipemia, and elevated levels of IL-4 and ferritin. Finally, viral shedding and proinflammatory responses were closely correlated with lung lesion evolutions on chest CT. : medRxiv preprint ConclusionsPatients with severe COVID-19 have prolonged SARS-CoV-2 infection and delayed intermittent viral shedding. Older age, hyperlipemia, hypoproteinemia, corticosteroid usage, and prolonged SARS-CoV-2 IgM positive might be utilized as predicative factors for the patients with poor recovery.

Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes

“…Ultimately, 25 COVID-19 studies reflecting 1245 patients were included for analysis. 2 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 Of these, 15 studies (n=650 patients) either included only patients with severe COVID-19 or allowed data abstraction specifically within the subgroup of patients with severe disease, whereas ten studies (n=367 patients) included only patients with critical COVID-19 or allowed data abstraction specifically within the subgroup of patients with critical illness. COVID-19 study details are provided in appendix 1 (p 11 ).…”

Deciphering the COVID‐19 cytokine storm: Systematic review and meta‐analysis

“…The sample size across all the studies ranged from 10 patients to 548 patients, and a total of 5209 males and females participated in the 40 studies included in our review. Of the total studies, 35 were case series 7,26‐59 and five were retrospective cohorts, 60‐64 based in hospitals in different parts of China. The participants were patients with a reverse transcription‐polymerase chain reaction (RT‐PCR)‐confirmed diagnosis of the novel coronavirus 2019, enrolled in the hospital within the four‐month duration of December 2019 to March 2020.…”

Persistence of Anti-SARS-CoV-2 Antibodies in Non-Hospitalized COVID-19 Convalescent Health Care Workers

“…Elevated IL-6 levels were detected in hospitalized patients and have been associated with ICU admission, respiratory failure, and poor prognosis in several studies [ 5 , 27 , 28 ]. Presently, conflicting results regarding IL-1b and IL-4 have been reported [ 29 , 30 , 31 ]. The elevation of pro-inflammatory cytokines, albeit being widely described in COVID-19 patients, does not seem presently to have prognostic value, because they do not always differentiate moderate cases from severe cases [ 32 ].…”