Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities

Background: Coronavirus disease 2019 (COVID-19) pandemic continues to escalate intensively worldwide. Massive studies on general populations with SARS-CoV-2 infection have revealed that pre-existing comorbidities were a major risk factor for the poor prognosis of COVID-19. Notably, 49–75% of COVID-1...

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Autores principales:	Weifang Liu, Chengzhang Yang, Yuan-gao Liao, Feng Wan, Lijin Lin, Xuewei Huang, Bing-Hong Zhang, Yufeng Yuan, Peng Zhang, Xiao-Jing Zhang, Zhi-Gang She, Lei Wang, Hongliang Li
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2022
Materias:	COVID-19 Risk factors Severity Mortality Without comorbidities Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/4897973ac6e340a089a6ef3f7544b83e
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spelling	oai:doaj.org-article:4897973ac6e340a089a6ef3f7544b83e2021-12-02T05:00:19ZRisk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities1876-034110.1016/j.jiph.2021.11.012https://doaj.org/article/4897973ac6e340a089a6ef3f7544b83e2022-01-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S1876034121003762https://doaj.org/toc/1876-0341Background: Coronavirus disease 2019 (COVID-19) pandemic continues to escalate intensively worldwide. Massive studies on general populations with SARS-CoV-2 infection have revealed that pre-existing comorbidities were a major risk factor for the poor prognosis of COVID-19. Notably, 49–75% of COVID-19 patients had no comorbidities, but this cohort would also progress to severe COVID-19 or even death. However, risk factors contributing to disease progression and death in patients without chronic comorbidities are largely unknown; thus, specific clinical interventions for those patients are challenging. Methods: A multicenter, retrospective study based on 4806 COVID-19 patients without chronic comorbidities was performed to identify potential risk factors contributing to COVID-19 progression and death using LASSO and a stepwise logistic regression model. Results: Among 4806 patients without pre-existing comorbidities, the proportions with severe progression and mortality were 34.29% and 2.10%, respectively. The median age was 47.00 years [interquartile range, 36.00–56.00], and 2162 (44.99%) were men. Among 51 clinical parameters on admission, age ≥ 47, oxygen saturation < 95%, increased lactate dehydrogenase, neutrophil count, direct bilirubin, creatine phosphokinase, blood urea nitrogen levels, dyspnea, increased blood glucose and prothrombin time levels were associated with COVID-19 mortality in the entire cohort. Of the 3647 patients diagnosed with non-severe COVID-19 on admission, 489(13.41%) progressed to severe disease. The risk factors associated with COVID-19 progression from non-severe to severe illness were increased procalcitonin levels, SpO2 < 95%, age ≥ 47, increased LDH, activated partial thromboplastin time levels, decreased high-density lipoprotein cholesterol levels, dyspnea and increased D-dimer levels. Conclusions: COVID-19 patients without pre-existing chronic comorbidities have specific traits and disease patterns. COVID-19 accompanied by severe bacterial infections, as indicated by increased procalcitonin levels, was highly associated with disease progression from non-severe to severe. Aging, impaired respiratory function, coagulation dysfunction, tissue injury, and lipid metabolism dysregulation were also associated with disease progression. Once factors for multi-organ damage were elevated and glucose increased at admission, these findings indicated a higher risk for mortality. This study provides information that helps to predict COVID-19 prognosis specifically in patients without chronic comorbidities.Weifang LiuChengzhang YangYuan-gao LiaoFeng WanLijin LinXuewei HuangBing-Hong ZhangYufeng YuanPeng ZhangXiao-Jing ZhangZhi-Gang SheLei WangHongliang LiElsevierarticleCOVID-19Risk factorsSeverityMortalityWithout comorbiditiesInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENJournal of Infection and Public Health, Vol 15, Iss 1, Pp 13-20 (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	COVID-19 Risk factors Severity Mortality Without comorbidities Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	COVID-19 Risk factors Severity Mortality Without comorbidities Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Weifang Liu Chengzhang Yang Yuan-gao Liao Feng Wan Lijin Lin Xuewei Huang Bing-Hong Zhang Yufeng Yuan Peng Zhang Xiao-Jing Zhang Zhi-Gang She Lei Wang Hongliang Li Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities
description	Background: Coronavirus disease 2019 (COVID-19) pandemic continues to escalate intensively worldwide. Massive studies on general populations with SARS-CoV-2 infection have revealed that pre-existing comorbidities were a major risk factor for the poor prognosis of COVID-19. Notably, 49–75% of COVID-19 patients had no comorbidities, but this cohort would also progress to severe COVID-19 or even death. However, risk factors contributing to disease progression and death in patients without chronic comorbidities are largely unknown; thus, specific clinical interventions for those patients are challenging. Methods: A multicenter, retrospective study based on 4806 COVID-19 patients without chronic comorbidities was performed to identify potential risk factors contributing to COVID-19 progression and death using LASSO and a stepwise logistic regression model. Results: Among 4806 patients without pre-existing comorbidities, the proportions with severe progression and mortality were 34.29% and 2.10%, respectively. The median age was 47.00 years [interquartile range, 36.00–56.00], and 2162 (44.99%) were men. Among 51 clinical parameters on admission, age ≥ 47, oxygen saturation < 95%, increased lactate dehydrogenase, neutrophil count, direct bilirubin, creatine phosphokinase, blood urea nitrogen levels, dyspnea, increased blood glucose and prothrombin time levels were associated with COVID-19 mortality in the entire cohort. Of the 3647 patients diagnosed with non-severe COVID-19 on admission, 489(13.41%) progressed to severe disease. The risk factors associated with COVID-19 progression from non-severe to severe illness were increased procalcitonin levels, SpO2 < 95%, age ≥ 47, increased LDH, activated partial thromboplastin time levels, decreased high-density lipoprotein cholesterol levels, dyspnea and increased D-dimer levels. Conclusions: COVID-19 patients without pre-existing chronic comorbidities have specific traits and disease patterns. COVID-19 accompanied by severe bacterial infections, as indicated by increased procalcitonin levels, was highly associated with disease progression from non-severe to severe. Aging, impaired respiratory function, coagulation dysfunction, tissue injury, and lipid metabolism dysregulation were also associated with disease progression. Once factors for multi-organ damage were elevated and glucose increased at admission, these findings indicated a higher risk for mortality. This study provides information that helps to predict COVID-19 prognosis specifically in patients without chronic comorbidities.
format	article
author	Weifang Liu Chengzhang Yang Yuan-gao Liao Feng Wan Lijin Lin Xuewei Huang Bing-Hong Zhang Yufeng Yuan Peng Zhang Xiao-Jing Zhang Zhi-Gang She Lei Wang Hongliang Li
author_facet	Weifang Liu Chengzhang Yang Yuan-gao Liao Feng Wan Lijin Lin Xuewei Huang Bing-Hong Zhang Yufeng Yuan Peng Zhang Xiao-Jing Zhang Zhi-Gang She Lei Wang Hongliang Li
author_sort	Weifang Liu
title	Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities
title_short	Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities
title_full	Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities
title_fullStr	Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities
title_full_unstemmed	Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities
title_sort	risk factors for covid-19 progression and mortality in hospitalized patients without pre-existing comorbidities
publisher	Elsevier
publishDate	2022
url	https://doaj.org/article/4897973ac6e340a089a6ef3f7544b83e
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Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities

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