Predictors associated with clinical improvement of SARS-CoV-2 pneumonia

Takahiro Mitsumura; Tsukasa Okamoto; Tsuyoshi Shirai; Yuki Iijima; Rie Sakakibara; Takayuki Honda; Masahiro Ishizuka; Junichi Aiboshi; Tomoya Tateishi; Meiyo Tamaoka; Hidenobu Shigemitsu; Hirokuni Arai; Yasuhiro Otomo; Shuji Tohda; Tatsuhiko Anzai; Kunihiko Takahashi; Shinsuke Yasuda; Yasunari Miyazaki

doi:10.1016/j.jiac.2021.02.012

Predictors associated with clinical improvement of SARS-CoV-2 pneumonia

J Infect Chemother. 2021 Jun;27(6):857-863. doi: 10.1016/j.jiac.2021.02.012. Epub 2021 Feb 16.

Authors

Takahiro Mitsumura¹, Tsukasa Okamoto¹, Tsuyoshi Shirai¹, Yuki Iijima¹, Rie Sakakibara¹, Takayuki Honda¹, Masahiro Ishizuka¹, Junichi Aiboshi², Tomoya Tateishi¹, Meiyo Tamaoka¹, Hidenobu Shigemitsu³, Hirokuni Arai⁴, Yasuhiro Otomo², Shuji Tohda⁵, Tatsuhiko Anzai⁶, Kunihiko Takahashi⁶, Shinsuke Yasuda⁷, Yasunari Miyazaki⁸

Affiliations

¹ Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
² Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
³ Department of Intensive Care Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
⁴ Department of Cardiovascular Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
⁵ Department of Laboratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
⁶ M&D Data Science Center, Tokyo Medical and Dental University, 2-3-10, Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan.
⁷ Department of Rheumatology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
⁸ Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. Electronic address: miyazaki.pilm@tmd.ac.jp.

Abstract

Background: There are few agents that have been proven effective for COVID-19. Predicting clinical improvement as well as mortality or severity is very important.

Objectives: This study aimed to investigate the factors associated with the clinical improvement of COVID-19.

Methods: Overall, 74 patients receiving treatment for COVID-19 at Tokyo Medical and Dental University Hospital from April 6th to May 15th, 2020 were included in this study. Clinical improvement was evaluated, which defined as the decline of two levels on a six-point ordinal scale of clinical status or discharge alive from the hospital within 28 days after admission. The clinical courses were particularly investigated and the factors related to time to clinical improvement were analyzed with the log-rank test and the Cox proportional hazard model.

Results: Forty-nine patients required oxygen support during hospitalization, 22 patients required invasive mechanical ventilation, and 5 patients required extracorporeal membrane oxygenation. A total of 83% of cases reached clinical improvement. Longer period of time from onset to admission (≥10 days) (HR, 1.057; 95% CI, 1.002-1.114), no hypertension (HR, 2.077; 95% CI, 1.006-4.287), and low D-dimer levels (<1 μg/ml) (HR, 2.372; 95% CI, 1.229-4.576) were confirmed to be significant predictive factors for time to clinical improvement. Furthermore, a lower SARS-CoV-2 RNA copy number was also a predictive factor for clinical improvement.

Conclusions: Several predictors for the clinical improvement of COVID-19 pneumonia were identified. These results may be important for the management of COVID-19 pneumonia.

Keywords: COVID-19; Clinical improvement; Pneumonia; SARS-CoV-2.

MeSH terms

Adult
Aged
COVID-19 / diagnosis
COVID-19 / therapy*
Extracorporeal Membrane Oxygenation
Female
Fibrin Fibrinogen Degradation Products / analysis
Hospitalization
Humans
Hypertension
Male
Middle Aged
RNA, Viral / isolation & purification
Respiration, Artificial
Tokyo

Substances

Fibrin Fibrinogen Degradation Products
RNA, Viral
fibrin fragment D