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. 2020 Jul 3;18(1):270.
doi: 10.1186/s12967-020-02423-8.

The timeline and risk factors of clinical progression of COVID-19 in Shenzhen, China

Fang Wang  1 , Mengyuan Qu  2 , Xuan Zhou  1 , Kai Zhao  2 , Changxiang Lai  1 , Qiyuan Tang  1 , Wenjie Xian  1 , Ruikun Chen  1 , Xuan Li  1 , Zhiyu Li  1 , Qing He  3 , Lei Liu  4
Affiliations

The timeline and risk factors of clinical progression of COVID-19 in Shenzhen, China

Fang Wang et al. J Transl Med. .

Abstract

Background: The novel coronavirus disease 2019 (COVID-19) broke out globally. Early prediction of the clinical progression was essential but still unclear. We aimed to evaluate the timeline of COVID-19 development and analyze risk factors of disease progression.

Methods: In this retrospective study, we included 333 patients with laboratory-confirmed COVID-19 infection hospitalized in the Third People's Hospital of Shenzhen from 10 January to 10 February 2020. Epidemiological feature, clinical records, laboratory and radiology manifestations were collected and analyzed. 323 patients with mild-moderate symptoms on admission were observed to determine whether they exacerbated to severe-critically ill conditions (progressive group) or not (stable group). We used logistic regression to identify the risk factors associated with clinical progression.

Results: Of all the 333 patients, 70 (21.0%) patients progressed into severe-critically ill conditions during hospitalization and assigned to the progressive group, 253 (76.0%) patients belonged to the stable group, another 10 patients were severe before admission. we found that the clinical features of aged over 40 (3.80 [1.72, 8.52]), males (2.21 [1.20, 4.07]), with comorbidities (1.78 [1.13, 2.81]) certain exposure history (0.38 [0.20, 0.71]), abnormal radiology manifestations (3.56 [1.13, 11.40]), low level of T lymphocytes (0.99 [0.997, 0.999]), high level of NLR (0.99 [0.97, 1.01]), IL-6 (1.05 [1.03, 1.07]) and CRP (1.67 [1.12, 2.47]) were the risk factors of disease progression by logistic regression.

Conclusions: The potential risk factors of males, older age, with comorbidities, low T lymphocyte level and high level of NLR, CRP, IL-6 can help to predict clinical progression of COVID-19 at an early stage.

Keywords: COVID-19; Clinical progression; Pneumonia; Retrospective analysis; Risk factor.

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Conflict of interest statement

No conflict of interest exits in the manuscript.

Figures

Fig. 1
Fig. 1
The epidemic trend and timeline in a COVID-19-designated hospital. a The outbreak of COVID-19 in Shenzhen according to official data from Jan. 10 to Feb. 28. b The admission date and onset date in the designated hospital. c The timeline of COVID-19 cases in the first month of admission
Fig. 2
Fig. 2
The distribution of age, symptom and baseline clinical characteristics. a The distribution of age in the COVID-19 patients; b The proportion of Clinical Severity of Confirmed COVID-19 Pneumonia on the admission (Left) and progressed period (Right). c The proportion in the progressed and stable patients
Fig. 3
Fig. 3
The ROC curve of age, T lymphocyte and CRP of the progressive and stable patients. a ROC curve of age; b ROC curve of T lymphocyte; c ROC curve of C-reactive protein
Fig. 4
Fig. 4
Comparison of the interval of disease progression between the progressive and stable patients. The interval of disease progression by age (a) and sex (b) by the Kaplan–Meier analysis
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