Background
Methods
Study design
Total(n = 252) | Non-critically ill (n = 200) | Critically ill (n = 52) | P value | |
---|---|---|---|---|
Age, years | 49(37–61) | 45 (35.25–56) | 64 (52–73) | < 0.0001 |
< 30 | 26 (10.30) | 25 (12.50) | 1 (1.90) | < 0.0001 |
30–39 | 48 (19.00) | 44 (22.00) | 4 (7.70) | |
40–49 | 58 (23.00) | 54 (27.00) | 4 (7.70) | |
50–59 | 50 (19.80) | 39 (19.50) | 11 (21.20) | |
60–69 | 44 (17.50) | 28 (14.00) | 16 (30.80) | |
70–79 | 16 (6.30) | 5 (2.50) | 11 (21.20) | |
≥ 80 | 10 (4.00) | 5 (2.50) | 5 (9.60) | |
Sex | ||||
Female | 111 (44.00) | 90 (45.00) | 21 (40.40) | 0.55 |
Male | 141 (56.00) | 110 (55.00) | 31 (59.60) | |
Signs and symptoms | ||||
Fever(≥ 37.3 °C) | 179 (71.00) | 150 (75.00) | 29 (55.80) | 0.006 |
Cough | 177 (70.20) | 136 (68.00) | 41 (78.80) | 0.128 |
Myalgia | 42 (16.70) | 35 (17.50) | 7 (13.50) | 0.486 |
Cephalalgia | 22 (8.70) | 18 (9.00) | 4 (7.70) | 0.983 |
Sputum | 105 (41.70) | 88 (44.00) | 17 (32.70) | 0.141 |
Hemoptysis | 4 (1.80) | 2 (1.20) | 2 (3.80) | 0.243 |
Diarrhoea | 28 (11.10) | 21 (10.50) | 7 (13.50) | 0.545 |
Dyspnea | 35 (13.90) | 6 (3.00) | 29 (55.80) | < 0.0001 |
Respiratory rate > 24 breaths per min | 26 (10.40) | 7 (3.60) | 19 (36.50) | < 0.0001 |
Comorbidity | ||||
Hypertension | 48 (19.00) | 28 (14.00) | 20 (38.50) | < 0.0001 |
Diabetes | 18 (7.20) | 10 (5.00) | 8 (15.70) | 0.019 |
Digestive tract disease | 4 (1.60) | 3 (1.50) | 1 (1.90) | 1 |
Cardiovascular disease | 10 (40) | 4 (2.00) | 6 (11.50) | 0.006 |
Cerebrovascular disease | 3 (1.20) | 1 (0.50) | 2 (3.80) | 0.109 |
Malignancy | 4 (1.60) | 1 (0.50) | 3 (5.80) | 0.029 |
Liver disease | 6 (2.40) | 3 (1.50) | 3 (5.80) | 0.198 |
Statistical analysis
Results
Demographics and clinical characteristics
Laboratory and radiographic findings
Reference values | Total (n = 252) | Non-critically ill (n = 200) | Critically ill (n = 52) | p value | |
---|---|---|---|---|---|
Laboratory findings | |||||
White blood cell count (X 109/L) | 3.50–9.50 | 5.05 (4.02–6.83) | 4.85 (3.88–6.30) | 6.45 (4.53–10.91) | < 0.0001 |
Lymphocyte count (X 109/L) | 1.10–3.20 | 1.03 (0.72–1.41) | 1.12 (0.74–1.51) | 0.79 (0.58–1.07) | 0.0003 |
Neutrophil count (X 109/L) | 1.80–6.30 | 3.28 (2.36–4.75) | 3.05 (2.31–4.19) | 4.87 (2.86–8.37) | < 0.0001 |
Monocyte count (X 109/L) | 0.10–0.60 | 0.36 (0.23–0.54) | 0.36 (0.22–0.55) | 0.36 (0.24–0.54) | 0.654 |
Platelet count (X 109/L) | 125.00–350.00 | 176.50 (141.00–217.00) | 174.50 (140.75–205.25) | 194.00 (148.00–274.50) | 0.063 |
NLR | 0.78–3.53 | 3.10 (2.01–5.62) | 2.74 (1.92–4.33) | 6.51 (2.54–14.12) | < 0.0001 |
APTT (s) | 21.00–37.00 | 30.20 (25.56–35.50) | 29.04 (25.41–34.43) | 34.20 (28.61–36.39) | 0.003 |
FIB (g/L) | 2.00–4.00 | 3.32 (2.68–4.10) | 3.20 (2.60–3.88) | 3.70 (3.11–4.86) | 0.0005 |
D-dimer (μg/mL) | 0.00–0.55 | 0.40 (0.28–0.61) | 0.37 (0.25–0.55) | 0.50 (0.31–1.30) | 0.007 |
ESR (mm/1 h) | 0.00–30.00 | 24.00 (12.00–40.00) | 20.00 (9.50–38.00) | 31.00 (23.75–45.25) | 0.002 |
PCT (ng/mL) | 0.00–0.50 | 0.11 (0.06–0.26) | 0.10 (0.05–0.25) | 0.24 (0.10–0.37) | < 0.0001 |
CRP (mg/L) | 0.00–10.00 | 15.75 (5.15–43.82) | 13.02(4.75–36.39) | 24.70 (6.89–100.19) | 0.001 |
LDH (U/L) | 91.00–230.00 | 193.40 (156.75–239.15) | 188.00 (151.00–236.00) | 226.00 (183.00–323.10) | 0.001 |
CK (U/L) | 25.00–200.00 | 99.00 (68.45–175.00) | 95.00 (70.00–170.50) | 150.00 (47.85–186.50) | 0.68 |
Creatinine (μmol/L) | 44.00–112.00 | 71.90 (59.00–85.93) | 71.40 (59.00–85.47) | 74.19 (62.05–86.00) | 0.829 |
BUN (mmol/L) | 2.50–7.10 | 4.35 (3.40–5.66) | 3.92 (3.25–5.37) | 5.41 (4.16–6.90) | < 0.0001 |
AST (U/L) | 0.00–40.00 | 31.00 (24.10–43.75) | 31.00 (24.00–41.00) | 37.00 (25.70–56.00) | 0.018 |
ALT (U/L) | 0.00–50.00 | 31.00 (17.00–45.40) | 29.00 (15.00–42.50) | 36.45 (22.48–56.03) | 0.01 |
TBIL (μmol/L) | 3.00–21.00 | 10.40 (7.60–16.85) | 9.80 (7.30–13.80) | 17.20 (8.65–23.53) | < 0.0001 |
SOFA score | 1.00 (0.00–3.00) | 1.00 (0.00–1.25) | 4.00 (3.00–5.00) | < 0.0001 | |
Imaging features | |||||
Ground-glass opacity | 62 (24.60) | 50 (25.00) | 12 (23.10) | 0.774 | |
Unilateral pulmonary abnormality | 45 (17.90) | 40 (20.00) | 5 (9.60) | 0.082 | |
Bilateral pulmonary abnormality | 179 (71.00) | 145 (72.50) | 34 (65.40) | 0.314 |
Treatments and outcomes
Total (n = 252) | Non-critically ill (n = 200) | Critically ill (n = 52) | p value | |
---|---|---|---|---|
Treatments | ||||
Antiviral treatment | 250 (99.20) | 200 (100.00) | 50 (96.20) | 0.042 |
Antibiotics | 202 (80.20) | 155 (77.50) | 47 (90.40) | 0.038 |
Corticosteroids | 28 (11.10) | 15 (7.50) | 13 (25.00) | 0.0003 |
Intravenous immunoglobin | 11 (4.40) | 1 (0.50) | 10 (19.20) | < 0.0001 |
Albumin | 7 (2.80) | 0 | 7 (13.50) | < 0.0001 |
Traditional Chinese medicine | 192 (76.20) | 160 (80.00) | 32 (61.50) | 0.005 |
Oxygen therapy | 200 (79.40) | 158 (79.00) | 42 (80.80) | 0.779 |
Mechanical ventilation | 10 (4.00) | 0 | 10 (19.20) | < 0.0001 |
ECMO | 4 (1.60) | 0 | 4 (7.70) | 0.002 |
Outcomes | ||||
ARDS | 21 (8.40) | 1 (0.50) | 20 (38.50) | < 0.0001 |
ICU admission | 43 (17.10) | 0 | 43 (82.70) | < 0.0001 |
Death | 6 (2.40) | 0 | 6 (11.50) | < 0.0001 |
Time from illness onset to dyspnea, days | 6 (2.75–9.25) | 5.00 (1.50–7.50) | 7 (3–10) | 0.294 |
Time from illness onset to ARDS, days | 9 (6.50–13.50) | 2 | 9.50 (7–13.75) | 0.137 |
Time from illness onset to ICU admission, days | 10 (6–18) | / | 10 (6–18) | |
length of hospital stay | 17 (14–20) | 17 (14–19) | 21.50 (17–27.75) | 0.001 |
Time from hospitalization to death | 8.50 (4–12) | / | 10 (6–18) |
Risk factors associated with critical illness
Univariable OR (95%CI) | p value | Multivariable OR (95%CI)a | p value | |
---|---|---|---|---|
Demographics and clinical characteristics | ||||
Age, years | 2.03 (1.61–2.62) | 8.92E-09 | ||
Baseline(< 30) | 1.00 (ref) | |||
30–39 | 2.27 (0.31–45.77) | 0.473534 | ||
40–49 | 1.85 (0.26–37.22) | 0.590015 | ||
50–59 | 7.05 (1.25–132.86) | 0.069253 | ||
60–69 | 14.29 (2.62–267.08) | 0.012654 | ||
70–79 | 55.00 (8.15–1132.20) | 0.000512 | ||
> 79 | 25.00 (3.18–538.98) | 0.007295 | ||
Female sex (vs male) | 1.19 (0.65–2.24) | 0.58 | ||
Dyspnea (vs not dyspnea) | 40.56 (16.19–117.96) | 1.28E-13 | 46.01 (15.36–169.48) | 2.30E-10 |
Respiratory rate > 24 breaths per min (vs respiratory rate ≤ 24 breaths per min) | 15.63 (6.34–42.77) | 1.07E-08 | 5.84 (1.53–23.01) | 0.00994 |
Comorbidity present (vs not present) | ||||
Hypertension | 3.84 (1.92–7.64) | 0.000123 | 1.45 (0.64–3.19) | 0.365 |
Diabetes | 3.53 (1.28–9.493) | 0.0121 | 1.74 (0.58–5.02) | 0.307 |
Digestive tract disease | 1.29 (0.06–10.29) | 0.828 | ||
Cardiovascular disease | 6.39 (1.76–25.87) | 0.00535 | 1.33 (0.32–6.00) | 0.697 |
Cerebrovascular disease | 7.96 (0.75–173.32) | 0.093 | ||
Carcinoma | 12.18 (1.52–249.22) | 0.032 | 2.57 (0.29–54.99) | 0.434 |
Liver disease | 4.02 (0.73–22.30) | 0.0944 | ||
Chronic obstructive lung disease | 1.29 (0.19–5.81) | 0.757 | ||
Laboratory findings | ||||
White blood cell count (×109/L) | 5.56 (2.69–12.43) | 9.59E-06 | 7.11 (3.04–18.43) | 1.75E-05 |
< 3.5 | 0.39 (0.09–1.16) | 0.131 | 0.19 (0.03–0.75) | 0.034956 |
3.5–9.5 | 1.00 (ref) | 1.00 (ref) | ||
> 9.5 | 7.94 (3.19–21.18) | 1.43E-05 | 8.38 (2.82–26.64) | 0.00018 |
Lymphocyte count (×109/L) | 0.33 (0.16–0.64) | 0.00144 | 0.49 (0.23–1.00) | 0.0584 |
< 1.1 | 3.68 (1.83–7.94) | 0.000452 | 2.41 (1.09–5.63) | 0.0342 |
1.1–3.2 | 1.00 (ref) | 1.00 (ref) | ||
> 3.2 | 4.18 (0.19–47.28) | 0.258274 | 1.96 (0.08–26.78) | 0.6238 |
Neutrophil count (x109/L) | 2.81 (1.54–5.31) | 0.00106 | 3.00 (1.50–6.30) | 0.00259 |
< 1.8 | 1.00 (0.35–2.49) | 0.998 | 0.94 (0.28–2.77) | 0.915091 |
1.8–6.3 | 1.00 (ref) | 1.00 (ref) | ||
> 6.3 | 5.13 (2.33–11.44) | 5.11E-05 | 6.03 (2.31–16.18) | 0.000268 |
Monocyte count(x109/L) | 1.35 (0.63–2.81) | 0.42501 | ||
< 0.1 | 3.69 (0.14–94.79) | 0.36 | ||
0.1–0.6 | 1.00 (ref) | |||
> 0.6 | 1.53 (0.69–3.21) | 0.274 | ||
Platelet count (x109/L) | 1.16 (0.55–2.57) | 0.698881 | ||
< 125 | 1.18 (0.49–2.62) | 0.693 | ||
125–350 | 1.00 (ref) | |||
> 350 | 3.68 (0.66–20.52) | 0.119 | ||
NLR | 3.92 (2.11–7.59) | 2.57E-05 | 4.17 (2.00–9.26) | 0.000231 |
< 0.78 | NAb | 0.986 | NA | 0.98938 |
0.78–3.53 | 1.00 (ref) | 1.00 (ref) | ||
> 3.53 | 3.73 (1.96–7.32) | 8.52E-05 | 3.78 (1.73–8.65) | 0.00113 |
APTT(s) | 1.90 (0.92–3.94) | 0.082165 | ||
< 21 | NA | 0.985 | ||
21–37 | 1.00 (ref) | |||
> 37 | 1.48 (0.63–3.30) | 0.352 | ||
fibrinogen(g/L) | 3.06 (1.58–5.99) | 0.000969 | 2.69 (1.27–5.84) | 0.01063 |
< 2 | NA | 0.9898 | NA | 0.9874 |
2–4 | 1.00 (ref) | 1.00 (ref) | ||
> 4 | 2.90 (1.46–5.77) | 0.0023 | 2.38 (1.07–5.33) | 0.0334 |
D-dimer (μg/mL) | 2.52 (1.29–4.96) | 0.00699 | 2.52 (1.14–5.63) | 0.0228 |
ESR (mm/1 h) | 2.18 (1.05–4.54) | 0.0364 | 2.54 (0.99–6.65) | 0.052685 |
Procalcitonin (ng/mL) | 4.40 (1.77–13.36) | 0.00337 | 2.83 (1.03–9.34) | 0.0598 |
CRP (mg/L) | 2.02 (1.04–4.09) | 0.0434 | 1.68 (0.76–3.90) | 0.210687 |
Lactate dehydrogenase (U/L) | 2.16 (1.16–4.13) | 0.0172 | 1.47 (0.71–3.12) | 0.30 |
< 91 | 0.34 (0.012–1.84) | 0.3101 | 0.38 (0.02–2.56) | 0.407692 |
91–230 | 1.00 (ref) | 1.00 (ref) | ||
> 230 | 2.04 (0.98–4.22) | 0.0539 | 1.29 (0.53–3.08) | 0.563397 |
Creatine kinase (U/L) | 1.77 (0.82–3.72) | 0.136 | ||
Creatinine (μmol/L) | 1.67 (0.62–4.73) | 0.3153 | ||
< 44 | 1.27 (0.26–4.77) | 0.7402 | ||
44–112 | 1.00 (ref) | |||
> 112 | 2.95 (0.79–11.09) | 0.0987 | ||
BUN (mmol/L) | 8.09 (2.84–29.37) | 0.000331 | 9.20 (2.87–38.15) | 0.000611 |
< 2.5 | 0.67 (0.10–2.76) | 0.622078 | 0.54 (0.05–3.14) | 0.54405 |
2.5–7.1 | 1.00 (ref) | 1.00 (ref) | ||
> 7.1 | 18.16 (4.68–120.23) | 0.000229 | 18.57 (4.23–133.27) | 0.00053 |
AST (U/L) | 2.30 (1.19–4.44) | 0.0131 | 2.29 (1.05–5.03) | 0.036656 |
ALT(U/L) | 2.28 (1.09–4.70) | 0.0269 | 3.67 (1.45–9.47) | 0.00615 |
Total bilirubin (μmol/L) | 5.71 (2.47–13.68) | 5.84E-05 | 5.53 (2.12–14.92) | 0.000548 |
< 3 | NA | 0.989 | NA | 0.990348 |
3–21 | 1.00 (ref) | 1.00 (ref) | ||
> 21 | 5.60 (2.40–13.50) | 8.12E-05 | 5.50 (2.10–14.88) | 0.000584 |
SOFA score | 2.88 (2.10–4.16) | 1.15E-09 | 2.77 (1.95–4.16) | 1.20E-07 |
0 | 1.00 (ref) | 1.00 (ref) | ||
1 | NA | 0.99253 | NA | 0.992699 |
2 | 14.68 (3.43–102.01) | 0.00112 | 10.72 (2.25–79.00) | 0.006283 |
3 | 36.64 (8.66–256.66) | 1.34E-05 | 35.09 (6.91–279.80) | 9.44E-05 |
4 | 108.50 (16.22–1247.72) | 1.34E-05 | 73.50 (9.45–9.52) | 0.000177 |
5 | 403.00 (49.95–9761.98) | 2.01E-06 | 474.72 (38.22–27,290.59) | 8.24E-05 |
6 | NA | 0.99582 | NA | 0.996041 |
7 | NA | 0.99759 | NA | 0.998477 |