Clinical characteristics and laboratory biomarkers changes in COVID-19 patients requiring or not intensive or sub-intensive care: a comparative study

BMC Infect Dis. 2020 Dec 9;20(1):934. doi: 10.1186/s12879-020-05647-7.


Background: Identifying risk factors for severe novel-coronavirus disease (COVID-19) is useful to ascertain which patients may benefit from advanced supportive care. The study offers a description of COVID-19 patients, admitted to a general ward for a non-critical clinical picture, with the aim to analyse the differences between those transferred to the intensive (ICU) and/or sub-intensive care (SICU) units and those who were not.

Methods: This observational retrospective study includes all COVID-19 patients admitted to the Infectious Diseases Unit. Clinical, laboratory, radiological and treatment data were collected. The primary outcome was a composite of need of transfer to the ICU and/or SICU during the hospitalization. Patients who did not require to be transferred are defined as Group 1; patients who were transferred to the ICU and/or SICU are defined as Group 2. Demographic, clinical characteristics and laboratory findings at the 1st, 3rd and last measurements were compared between the two groups.

Results: 303 were included. The median age was 62 years. 69 patients (22.8%) met the primary outcome and were defined as Group 2. The overall fatality rate was 6.8%. Group 2 patients were predominantly male (76.8% vs. 55.1%, p < 0.01), had a higher fatality rate (14.5% vs. 3.8%, p < 0,01), had more hypertension (72.4% vs. 44%, p < 0,01) and diabetes (31.9% vs. 21%, p = 0.04) and were more likely to present dry cough (49.3% vs. 25.2%, p < 0.01). Overall, chest X-ray at admission showed findings suggestive of pneumonia in 63.2%, and Group 2 were more likely to develop pathological findings during the hospitalization (72.7% vs. 17.2%, p = 0.01). At admission, Group 2 presented significantly higher neutrophil count, aspartate-transaminase and C-Reactive-Protein. At the 3rd measurement, Group 2 presented persistently higher neutrophil count, hepatic inflammation markers and C-Reactive-Protein. Group 1 presented a shorter duration from admission to negativization of follow-up swabs (20 vs. 35 days, p < 0.01).

Conclusions: The presence of comorbidities and the persistent observation of abnormal laboratory findings should be regarded as predisposing factors for clinical worsening.

Keywords: COVID-19; Disease severity; Intensive care; Novel coronavirus; Outcome; SARS-CoV-2; Sub-intensive care.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Aged
  • Aspartate Aminotransferases / blood
  • Biomarkers / blood
  • C-Reactive Protein / analysis
  • COVID-19 / blood*
  • COVID-19 / epidemiology
  • COVID-19 / therapy*
  • COVID-19 / virology
  • Comorbidity
  • Critical Care / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Intensive Care Units
  • Italy / epidemiology
  • Leukocyte Count
  • Male
  • Middle Aged
  • Neutrophils / immunology
  • Patient Transfer*
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2 / genetics*
  • Time Factors


  • Biomarkers
  • C-Reactive Protein
  • Aspartate Aminotransferases