Clinical features and predictors for patients with severe SARS-CoV-2 pneumonia at the start of the pandemic: a retrospective multicenter cohort study

  1. Chao Cao
  2. Li He
  3. Jingping Ma
  4. Meiping Chen
  5. Yiting Li
  6. Qingwen Jiang
  7. Shiyu Wu
  8. Lili Yu
  9. Weina Huang
  10. Guoqing Qian
  11. Chuanbing Zhu
  12. Jinguo Chu
  13. Xiaomin Chen

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Abstract

Background

This study was performed to investigate clinical features of patients with severe SARS-CoV-2 pneumonia and identify risk factors for converting to severe cases in those who had mild to moderate diseases at the start of the pandemic in China.

Methods

In this retrospective, multicenter cohort study, patients with mild to moderate SARS-CoV-2 pneumonia were included. Demographic data, symptoms, laboratory values, and clinical outcomes were collected. Data were compared between non-severe and severe patients.

Results

58 patients were included in the final analysis. Compared with non-severe cases, severe patients with SARS-CoV-2 pneumonia had a longer: time to clinical recovery (12·9 ± 4·4 vs 8·3 ± 4·7; P  = 0·0011), duration of viral shedding (15·7 ± 6·7 vs 11·8 ± 5·0; P  = 0·0183), and hospital stay (20·7 ± 1·2 vs 14·4 ± 4·3; P  = 0·0211). Multivariate logistic regression indicated that lymphocyte count was significantly associated with the rate of converting to severe cases (odds ratio 1·28, 95%CI 1·06–1·54, per 0·1 ×  10 9 /L reduced; P  = 0·007), while using of low-to-moderate doses of systematic corticosteroids was associated with reduced likelihood of converting to a severe case (odds ratio 0·14, 95%CI 0·02–0·80; P  = 0·0275).

Conclusions

The low peripheral blood lymphocyte count was an independent risk factor for SARS-CoV-2 pneumonia patients converting to severe cases. However, this study was carried out right after the start of the pandemic with small sample size. Further prospective studies are warranted to confirm these findings.

Trial registration

Chinese Clinical Trial Registry, ChiCTR2000029839 . Registered 15 February 2020 - Retrospectively registered.

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  1. Version published to 10.1186/s12879-021-06335-w
  2. ScreenIT

    SciScore for 10.1101/2020.06.01.20119032: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethical approvals for this study were obtained from the Ethics Commission of Ningbo First Hospital (2020-R017) and the Ethics Commission of Jingzhou Central Hospital (2020–2–19).
    Consent: Written informed consent was waived due to the rapid emergence of this disease.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analyses were conducted using SPSS version 180 (SPSS, Chicago, IL, USA) and SAS version 9.4 (SAS Institute, Cary, North Carolina).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Some limitations of this study should be acknowledged. Firstly, this was a retrospective study with a limited sample size, if the conclusion generalized is to be widely used, it would still need a prospective large-scale clinical validation. Secondly, different varieties of traditional Chinese medicine were administered to most patients, and the effectiveness and potential adverse effects of those drugs given remain largely unknown. Thirdly, examinations of lymphocyte subsets were undertaken in this study, and in addition, total lymphocyte counts were not observed dynamically. Despite the above limitations, we believe that our study has shown important and novel findings about the predictors of severe cases in mild to moderate patients with SARS-CoV-2 pneumonia. To our knowledge, this is the first study that has demonstrated that lymphocyte count is a useful predictor for severity of SARS-CoV-2 pneumonia. This may help clinicians more accurately predict prognosis, and triage priorities to improve clinical outcomes. The findings from this study showed that low lymphocyte count (< 1.1×109/L) in peripheral blood was an independent risk factor for patients who converted to severe cases. In addition, using of systematic corticosteroids in mild to moderate patients with SARS-CoV-2 pneumonia was associated with a reduced risk of converting to severe cases. Further prospective studies are warranted to confirm these findings.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.06.01.20119032v1 on medRxiv