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Observational Study
. 2021 Apr;93(4):2141-2148.
doi: 10.1002/jmv.26599. Epub 2020 Nov 1.

Early clinical factors predicting the development of critical disease in Japanese patients with COVID-19: A single-center, retrospective, observational study

Takatoshi Higuchi  1 , Tsutomu Nishida  2 , Hiromi Iwahashi  1 , Osamu Morimura  1 , Yasushi Otani  1 , Yukiyoshi Okauchi  1 , Masaru Yokoe  3 , Norihiro Suzuki  4 , Masami Inada  2 , Kinya Abe  1   4
Affiliations
Observational Study

Early clinical factors predicting the development of critical disease in Japanese patients with COVID-19: A single-center, retrospective, observational study

Takatoshi Higuchi et al. J Med Virol. 2021 Apr.

Abstract

The factors predicting the progression of coronavirus disease-2019 (COVID-19) from mild to moderate to critical are unclear. We retrospectively evaluated risk factors for disease progression in Japanese patients with COVID-19. Seventy-four patients with laboratory-confirmed COVID-19 were hospitalized in our hospital between February 20, 2020, and June 10, 2020. We excluded asymptomatic, non-Japanese, and pediatric patients. We divided patients into the stable group and the progression group (PG; requiring mechanical ventilation). We compared the clinical factors. We established the cutoff values (COVs) for significantly different factors via receiver operating characteristic curve analysis and identified risk factors by univariate regression. We enrolled 57 patients with COVID-19 (median age 52 years, 56.1% male). The median time from symptom onset to admission was 8 days. Seven patients developed critical disease (PG: 12.2%), two (3.5%) of whom died; 50 had stable disease. Univariate logistic analysis identified an elevated lactate dehydrogenase (LDH) level (COV: 309 U/l), a decreased estimated glomerular filtration rate (eGFR; COV: 68 ml/min), lymphocytopenia (COV: 980/μl), and statin use as significantly associated with disease progression. However, in the Cox proportional hazards analysis, lymphocytopenia at admission was not significant. We identified three candidate risk factors for progression to critical COVID-19 in adult Japanese patients: statin use, elevated LDH level, and decreased eGFR.

Keywords: COVID-19; Japanese patients; comorbidity; critical disease; disease progression; laboratory finding; risk factors.

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Conflict of interest statement

The authors report that they have no conflicts of interest. The authors alone are responsible for the content and writing of this paper.

Figures

Figure 1
Figure 1
Flow chart of patient enrollment. COVID‐19, coronavirus disease‐2019; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2
Figure 2
Figure 2
Overall progression‐free interval in patients with mild to moderate COVID‐19. Significant differences were found in the progression‐free interval between patients stratified by statin use, LDH levels and eGFRs at admission. COVID‐19, coronavirus disease‐2019; eGFR, estimated glomerular filtration rate; LDH, lactate dehydrogenase
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