Clinical Predictors of COVID-19 Disease Progression and Death: Analysis of 214 Hospitalized Patients from Wuhan, China.

INTRODUCTION: COVID-19 has spread rapidly worldwide and has been declared a pandemic. OBJECTIVES: To delineate clinical features of COVID-19 patients with different severities and prognoses and clarify the risk factors for disease progression and death at an early stage. METHODS: Medical history, laboratory findings, treatment, and outcome data from 214 hospitalized patients with COVID-19 pneumonia admitted to Eastern Campus of Renmin Hospital, Wuhan University in China were collected from January 30, 2020 to February 20, 2020, and risk factors associated with clinical deterioration and death were analyzed. The final date of follow-up was March 21, 2020. RESULTS: Age, comorbidities, higher neutrophil cell counts, lower lymphocyte counts and subsets, impairment of liver, renal, heart, coagulation systems, systematic inflammation and clinical scores at admission were significantly associated with disease severity. Ten (16.1%) moderate and 45 (47.9%) severe patients experienced deterioration after admission, and median time from illness onset to clinical deterioration was 14.7 (IQR 11.3-18.5) and 14.5 days (IQR 11.8-20.0) respectively. Multivariate analysis showed increased Hazards Ratio of disease progression associated with older age, lymphocyte count 9.5mmol/L, lactate dehydrogenase > 250 U/L and procalcitonin > 0.1 ng/mL at admission. These factors were also associated with risk of death except for BUN. Prediction models in terms of nomogram for clinical deterioration and death were established to illustrate the probability. CONCLUSIONS: These findings provide insights for early detection and management of patients at risk of disease progression or even death, especially older patients and those with comorbidities.