Clinical and laboratory predictors for disease progression in patients with COVID-19: A multi-center cohort study

Abstract

Background: Reliable clinical and laboratory predictors of coronavirus disease 2019 (COVID-19) disease progression could help to identify the subset of patients who are susceptible to severe symptoms. This study sought to identify the predictors for disease progression in patients with COVID-19.

Methods: This study recruited consecutive patients from four hospitals between March 1, 2020, and July 31, 2021. Demographic characteristics, laboratory results, and clinical outcomes were collected.

Results: Among the 239 enrolled patients, 39.3% (94/239) experienced in-hospital disease progression. Multivariate logistic regression revealed that coronary arterial disease (CAD) (OR, 4.15; 95% C.I., 1.47-11.66), cerebrovascular attack (CVA) (OR, 12.98; 95% C.I., 1.30-129.51), platelet count < median value (OR, 3.23; 95% C.I., 1.65-6.32), and C-reactive protein (CRP) levels > median value of (OR, 2.25; 95% C.I., 1.02-4.99) were independent factors associated with COVID-19 progression. Patients who underwent disease progression at days 1, 4, and 7 presented lower lymphocyte counts and higher CRP levels, compared to patients without disease progression.

Conclusions: The study revealed that in hospitalized COVID-19 patients, comorbidity with CAD and CVA, low platelet count, and elevated CRP levels were independently associated with disease progression. Compared with patients without disease progression, those with disease progression presented persistently low lymphocyte counts and elevated CRP levels.

Keywords: COVID-19; Outcomes; Progression.

Fig. 1

Relationship between serial laboratory parameters and disease progression in the cohort of COVID-19 patients. White blood cell (WBC) count (A), lymphocyte count (B), D-dimer (C), LDH (D), CRP (E), and ferritin (F) in patients with (+, red circle) or without (−, blue circle) disease progression were measured on days 0, 4, and 7. ∗p < 0.05 indicates a significant difference between patients with or without disease progression on the same day. Data are expressed as mean ± SEM.

Fig. 2

Relationship between serial laboratory parameters and disease progression in COVID-19 patients of mild/moderate severity. White blood cell (WBC) count (A), lymphocyte count (B), D-dimer (C), LDH (D), CRP (E), and ferritin (F) in patients with (+, red circle) or without (−, blue circle) disease progression were measured on days 0, 4, and 7. ∗p < 0.05 indicates a significant difference between patients with or without disease progression on the same day. Data are expressed as mean ± SEM.

Fig. 3

Relationship between serial laboratory parameters and disease progression in severe/critical COVID-19 patients. White blood cell (WBC) count (A), lymphocyte count (B), D-dimer (C), LDH (D), CRP (E), and ferritin (F) in patients with (+, red circle) or without (−, blue circle) disease progression were measured on days 0, 4, and 7. ∗p < 0.05 indicates difference between patients with or without disease progression on the same day. Data are expressed as mean ± SEM.

Fig. 4

PCR cycle threshold (Ct) values in patients with or without disease progression from day 1 to day 10. Ct values of patients with disease progression (+, red circle) or without (−, blue circle) were measured in the entire cohort (A), patients of mid/moderate severity (B), and severe/critical patients (C). ∗p < 0.05 indicates a significant difference between patients with or without disease progression on the same day. Data are expressed as mean ± SEM.