Risk factors for developing into critical COVID-19 patients in Wuhan, China: A multicenter, retrospective, cohort study

Abstract

Background: The ferocious global assault of COVID-19 continues. Critically ill patients witnessed significantly higher mortality than severe and moderate ones. Herein, we aim to comprehensively delineate clinical features of COVID-19 and explore risk factors of developing critical disease.

Methods: This is a Mini-national multicenter, retrospective, cohort study involving 2,387 consecutive COVID-19 inpatients that underwent discharge or death between January 27 and March 21, 2020. After quality control, 2,044 COVID-19 inpatients were enrolled. Electronic medical records were collected to identify the risk factors of developing critical COVID-19.

Findings: The severity of COVID-19 climbed up straightly with age. Critical group was characterized by higher proportion of dyspnea, systemic organ damage, and long-lasting inflammatory storm. All-cause mortality of critical group was 85•45%, by contrast with 0•58% for severe group and 0•18% for moderate group. Logistic regression revealed that sex was an effect modifier for hypertension and coronary heart disease (CHD), where hypertension and CHD were risk factors solely in males. Multivariable regression showed increasing odds of critical illness associated with hypertension, CHD, tumor, and age ≥ 60 years for male, and chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), tumor, and age ≥ 60 years for female.

Interpretation: We provide comprehensive front-line information about different severity of COVID-19 and insights into different risk factors associated with critical COVID-19 between sexes. These results highlight the significance of dividing risk factors between sexes in clinical and epidemiologic works of COVID-19, and perhaps other coronavirus appearing in future.

Funding: 10.13039/100000001 National Science Foundation of China.

Keywords: Covid-19; Risk factors; Severity of disease; Sex.

Fig. 1

the flowchart of this study.

Fig. 2

Medical teams supporting Wuhan and the number of patients they are in charge in two branches of Tongji Hospital. OVB=Optical Valley Branch, SFNCB= Sino-French New City Branch, TJ= Tongji.

Fig. 3

Dynamic changes in laboratory markers from illness onset in patients with COVID-19. Figure shows temporal changes in the median and IQR of interleukin-6 (A), high-sensitivity C-reactive protein (B), leukocyte count (C), lymphocyte count (D), D-dimer (E), and high-sensitivity cardiac troponin I (F). The overall differences among moderate, severe and critical group were significant for all timepoints shown. COVID-19=coronavirus disease 2019.

Fig. 4

Different effects of hypertension and CHD in male and female patients with COVID-19. A. The proportions of critical disease in male and female patients with or without hypertension in different age groups were shown. B. The probabilities of developing into critical or severe/critical disease were predicted using logistic regression models containing age, gender, hypertension, and the interaction term of gender and hypertension. Age-adjusted P values for hypertension in different genders were shown. C. The probabilities of developing into critical or severe/critical disease were predicted using logistic regression models containing age, gender, CHD, and the interaction term of gender and CHD. Age-adjusted P values for CHD in different genders were shown. COVID-19=coronavirus disease 2019. CHD=coronary heart disease.