Evaluation of the Risk of Clinical Deterioration among Inpatients with COVID-19

Víctor O Costa; Eveline M Nicolini; Bruna M A da Costa; Fabrício M Teixeira; Júlia P Ferreira; Marcos A Moura; Jorge Montessi; Rogério L Campos; Andrea N Guaraldo; Patrícia M Costa

doi:10.1155/2021/6689669

Evaluation of the Risk of Clinical Deterioration among Inpatients with COVID-19

Adv Virol. 2021 Jun 25:2021:6689669. doi: 10.1155/2021/6689669. eCollection 2021.

Affiliations

¹ Medicine, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora-SUPREMA, Juiz de Fora 36033-003, Brazil.
² Thoracic Surgery, Hospital Monte Sinai, Juiz de Fora 36033-318, Brazil.
³ Nursing, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora-Suprema, Juiz de Fora 36033-003, Brazil.
⁴ Infectology, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora-Suprema, Juiz de Fora 36033-003, Brazil.
⁵ Psychiatrist and Emergency, Hospital Monte Sinai, Juiz de Fora 36033-318, Brazil.
⁶ Intensive Therapy, Hospital Monte Sinai, Juiz de Fora 36033-318, Brazil.
⁷ Intensive Therapy and Dermatology Hospital Monte Sinai, Juiz de Fora 36033-318, Brazil.

Abstract

This study aims to assess the risk of severe forms of COVID-19, based on clinical, laboratory, and imaging markers in patients initially admitted to the ward. This is a retrospective observational study, with data from electronic medical records of inpatients, with laboratory confirmation of COVID-19, between March and September 2020, in a hospital from Juiz de Fora-MG, Brazil. Participants (n = 74) were separated into two groups by clinical evolution: those who remained in the ward and those who progressed to the ICU. Mann-Whitney U test was taken for continuous variables and the chi-square test or Fisher's exact test for categorical variables. Comparing the proposed groups, lower values of lymphocytes (p = <0.001) and increases in serum creatinine (p = 0.009), LDH (p = 0.057), troponin (p = 0.018), IL-6 (p = 0.053), complement C4 (p = 0.040), and CRP (p = 0.053) showed significant differences or statistical tendency for clinical deterioration. The average age of the groups was 47.9 ± 16.5 and 66.5 ± 7.3 years (p = 0.001). Hypertension (p = 0.064), heart disease (p = 0.048), and COPD (p = 0.039) were more linked to ICU admission, as well as the presence of tachypnea on admission (p = 0.051). Ground-glass involvement >25% of the lung parenchyma or pleural effusion on chest CT showed association with evolution to ICU (p = 0.027), as well as bilateral opacifications (p = 0.030) when compared to unilateral ones. Laboratory, clinical, and imaging markers may have significant relation with worse outcomes and the need for intensive treatment, being helpful as predictive factors.