Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

Bibliographic Data

ID23314704
AuthorsChaomin Wu (Fudan University), Xiaoyan Chen (0009-0001-2179-4968, Fudan University), Yanping Cai (0000-0002-9299-8335, Jinyintan Hospital), Jiaan Xia (Jinyintan Hospital), Jia’an Xia (Jinyintan Hospital), Xing Zhou (0009-0001-9528-731X, Shanghai Jiao Tong University), Sha Xu (0009-0002-6916-7813, Jinyintan Hospital), Han-Ping Huang (Jinyintan Hospital), Hanping Huang (Jinyintan Hospital), Li Zhang (0000-0002-4441-5131, Jinyintan Hospital), Xia Zhou (0000-0001-7478-6542, Shanghai Jiao Tong University), Chunling Du (0000-0002-4252-932X, Fudan University), Yuye Zhang (0000-0003-1213-5079, Fudan University), Juan Song (0000-0001-8161-6787, Fudan University), Sijiao Wang (0000-0003-1380-3171, Fudan University), Yencheng Chao (0000-0002-0636-6252, Fudan University), Zeyong Yang (0000-0003-1331-0836, Shanghai Jiao Tong University), Jie Xu (0000-0001-5291-5198, Guhua Hospital), Xin Zhou (0000-0003-2640-6431, Shanghai Jiao Tong University), Dechang Chen (0000-0001-8629-7033, Shanghai Jiao Tong University), Weining Xiong (0000-0002-3075-9750, Shanghai Jiao Tong University), Lei Xu (0009-0000-3744-0753, Second Military Medical University), Feng Zhou (0000-0002-4509-4026, Fudan University), Jinjun Jiang (0000-0003-2730-3872, Fudan University), Chunxue Bai (0000-0001-5798-3130, Fudan University), Junhua Zheng (0000-0001-8492-3141, Shanghai Jiao Tong University, corresponding author), Yuanlin Song (0000-0002-9826-4383, Fudan University, corresponding author)
Year2020
Volume180
Issue7
Pages934
Publication date2020-07-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueJAMA Internal Medicine (JOURNAL)
Journal identifiersISSN: 2168-6106 • E-ISSN: 2168-6114
PublisherAmerican Medical Association (AMA) (PUBLISHER)
DOI10.1001/jamainternmed.2020.0994
PMID32167524
OpenAlexW3011610993
LanguageEN
Citations received149
References cited21

Importance: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Risk factors for the clinical outcomes of COVID-19 pneumonia have not yet been well delineated. Objective: To describe the clinical characteristics and outcomes in patients with COVID-19 pneumonia who developed acute respiratory distress syndrome (ARDS) or died. Design, Setting, and Participants: Retrospective cohort study of 201 patients with confirmed COVID-19 pneumonia admitted to Wuhan Jinyintan Hospital in China between December 25, 2019, and January 26, 2020. The final date of follow-up was February 13, 2020. Exposures: Confirmed COVID-19 pneumonia. Main Outcomes and Measures: The development of ARDS and death. Epidemiological, demographic, clinical, laboratory, management, treatment, and outcome data were also collected and analyzed. Results: Of 201 patients, the median age was 51 years (interquartile range, 43-60 years), and 128 (63.7%) patients were men. Eighty-four patients (41.8%) developed ARDS, and of those 84 patients, 44 (52.4%) died. In those who developed ARDS, compared with those who did not, more patients presented with dyspnea (50 of 84 [59.5%] patients and 30 of 117 [25.6%] patients, respectively [difference, 33.9%; 95% CI, 19.7%-48.1%]) and had comorbidities such as hypertension (23 of 84 [27.4%] patients and 16 of 117 [13.7%] patients, respectively [difference, 13.7%; 95% CI, 1.3%-26.1%]) and diabetes (16 of 84 [19.0%] patients and 6 of 117 [5.1%] patients, respectively [difference, 13.9%; 95% CI, 3.6%-24.2%]). In bivariate Cox regression analysis, risk factors associated with the development of ARDS and progression from ARDS to death included older age (hazard ratio [HR], 3.26; 95% CI 2.08-5.11; and HR, 6.17; 95% CI, 3.26-11.67, respectively), neutrophilia (HR, 1.14; 95% CI, 1.09-1.19; and HR, 1.08; 95% CI, 1.01-1.17, respectively), and organ and coagulation dysfunction (eg, higher lactate dehydrogenase [HR, 1.61; 95% CI, 1.44-1.79; and HR, 1.30; 95% CI, 1.11-1.52, respectively] and D-dimer [HR, 1.03; 95% CI, 1.01-1.04; and HR, 1.02; 95% CI, 1.01-1.04, respectively]). High fever (≥39 °C) was associated with higher likelihood of ARDS development (HR, 1.77; 95% CI, 1.11-2.84) and lower likelihood of death (HR, 0.41; 95% CI, 0.21-0.82). Among patients with ARDS, treatment with methylprednisolone decreased the risk of death (HR, 0.38; 95% CI, 0.20-0.72). Conclusions and Relevance: Older age was associated with greater risk of development of ARDS and death likely owing to less rigorous immune response. Although high fever was associated with the development of ARDS, it was also associated with better outcomes among patients with ARDS. Moreover, treatment with methylprednisolone may be beneficial for patients who develop ARDS.

ARDS · Comorbidity · Interquartile range · Lung · Pneumonia · Retrospective cohort study · COVID-19 Clinical Research Studies · Epidemiology · Internal Medicine · Long-Term Effects of COVID-19 · Medicine · Pharmacological Receptor Mechanisms and Effects · Pediatrics