Risk factors for disease progression in COVID-19 patients

Abstract

Background: Coronavirus disease (COVID-19) is rapidly spreading worldwide. Although 10-20% of patients with COVID-19 have severe symptoms, little is known about the risk factors related to the aggravation of COVID-19 symptoms from asymptomatic or mild to severe disease states.

Methods: This retrospective study included 211 patients who were asymptomatic or with mild presentations of COVID-19. We evaluated the differences in demographic and clinical data between the cured (discharged to home) and transferred (aggravated to severe-stage COVID-19) groups.

Results: A multivariate logistic analysis showed that body temperature, chills, initial chest X-ray findings, and the presence of diabetes were significantly associated with predicting the progression to severe stage of COVID-19 (p < 0.05). The odds ratio of transfer in patients with COVID-19 increased by 12.7-fold for abnormal findings such as haziness or consolidation in initial chest X-ray, 6.32-fold for initial symptom of chills, and 64.1-fold for diabetes.

Conclusions: Even if patients are asymptomatic or have mild symptoms, clinicians should closely observe patients with COVID-19 presenting with chills, body temperature > 37.5 °C, findings of pneumonia in chest X-ray, or diabetes.

Keywords: Chilling; Coronavirus disease; Diabetes; Fever; Risk factor: symptom aggravation.

Fig. 1

The area under the receiver operating characteristic (ROC) curve for age predicting non-survival was 0.742 (95% confidence interval [CI], 0.646–0.936; p < 0.001). The optimal cutoff value obtained from the maximum Youden index J was 37.5 (sensitivity: 61.5%, specificity: 90.4%) and the odds ratio of progression to severe COVID-19 increased by 1.24-fold for every 0.1 °C increase in body temperature