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Multicenter Study
. 2020 Dec;8(4):584-594.
doi: 10.1002/iid3.343. Epub 2020 Aug 28.

Disease progression patterns and risk factors associated with mortality in deceased patients with COVID-19 in Hubei Province, China

Liang Chen  1 , Song Liu  2 , Juncai Tian  3 , Haisong Pan  1 , Yu Liu  1 , Jun Hu  1 , Maoren Wang  4 , Xuewen Hou  5
Affiliations
Multicenter Study

Disease progression patterns and risk factors associated with mortality in deceased patients with COVID-19 in Hubei Province, China

Liang Chen et al. Immun Inflamm Dis. 2020 Dec.

Abstract

Background: Detailed descriptions of the patterns of disease progression of deceased coronavirus disease 2019 (COVID-19) patients have not been well explored.

Objectives: This study sought to explore disease progression patterns and risk factors associated with mortality of deceased patients with COVID-19.

Materials and methods: Epidemiological, clinical, laboratory, and imaging data (from 15 January to 26 March 2020) of laboratory-confirmed COVID-19 patients were collected retrospectively from two hospitals, Hubei province, China. Disease progression patterns of patients were analyzed based on laboratory data, radiological findings, and Sequential Organ Failure Assessment (SOFA) score. Risk factors associated with death were analyzed.

Results: A total of 792 patients were enrolled in this study, of whom 68 died and 724 survived. Complications during hospitalization, such as sepsis, severe acute respiratory distress syndrome, acute cardiac injury, and acute kidney injury, were markedly more frequent in deceased patients than in surviving patients. Deceased patients presented progressive deterioration pattern in laboratory variables, chest computed tomography evaluation, and SOFA score, while surviving patients presented initial deterioration to peak level involvement followed by improvement pattern over time. Days 10 to 14 after illness onset was a critical stage of disease course. Older age, number of preexisting comorbidities ≥2, and SOFA score were independently associated with death for COVID-19.

Conclusions: Multiorgan dysfunction was common in deceased COVID-19 patients. Deceased patients presented progressive deterioration pattern, while surviving patients presented a relatively stable pattern during disease progression. Older age, number of preexisting comorbidities ≥2, and SOFA score were independent risk factors for death for COVID-19.

Keywords: COVID-19; SARS-CoV-2; SOFA score; disease progression pattern.

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Pattern of dynamic changes in laboratory markers after disease onset in patients with COVID‐19. The graph shows dynamic changes in high‐sensitivity cardiac troponin I (A), d‐dimer (B), lactate dehydrogenase (C), blood urea nitrogen (D), serum creatinine (E), and lymphocytes (F) between patients who nonsurvivors (progressive deterioration pattern) and survivors (initial deterioration to peak level involvement followed by improvement pattern). COVID‐19, coronavirus disease 2019
Figure 2
Figure 2
Pattern of dynamic changes in the total CT score and CT image pattern of lung lesions from disease onset in patients with COVID‐19. The graph shows dynamic changes in mean total CT score (A), percentage of consolidation (C), and percentage of mixed pattern (E) between nonsurvivors (progressive deterioration pattern) and survivors (initial deterioration to peak level involvement followed by improvement pattern). Percentage of ground‐grass opacity (B) is persistent more than 50% both in nonsurvivors and survivors within 28 days from illness onset, while the percentage of crazy‐paving pattern (D) is persistently increased until days 10 to 13, followed by decreased and no observed on days 21 to 28 both in nonsurvivors and survivors. COVID‐19, coronavirus disease 2019; CT, computed tomography
Figure 3
Figure 3
CT pattern of progression (upper panel A‐D) in an 83‐year‐old female deceased patient with fever and shortness of breath for 3 days. A, Initial CT (3 days from onset) only shows interlobular septal thickening in both lobes. B, Follow‐up CT obtained 5 days later shows multiple bilateral ground‐glass opacities (GGOs). C, Subsequent follow‐up CT obtained after another 3 days shows bilateral progressive CT progression. D, Final CT obtained after another 16 days shows “white lung” in both lungs, and the patient died of respiratory failure after 2 days. CT pattern of progression (lower panel A‐D) in a 48‐year‐old male recovered patient who presented with fever and cough for 3 days. A, Initial CT (3 days from onset): multiple irregular GGOs distributed bilaterally are shown. B, On day 7, there was a diffuse enlargement of GGO with partial consolidation and increased density. C, Day 10, further deteriorated GGO, which reached a peak level, with consolidation and air bronchogram. D, On day 19, the obvious resolution of GGO with fibrous stripes was observed. CT, computed tomography
Figure 4
Figure 4
Dynamic changes in the SOFA score from disease onset in patients with COVID‐19. The graph shows dynamic changes in SOFA score between patients who nonsurvivors (progressive deterioration pattern) and survivors (initial deterioration to peak level involvement followed by improvement pattern). COVID‐19, coronavirus disease 2019; SOFA, Sequential Organ Failure Assessment
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