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      Risk factors for disease severity, unimprovement, and mortality of COVID-19 patients in Wuhan, China

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          Abstract

          Objective

          Since December 2019, coronavirus disease (COVID-19) emerged in Wuhan. However, the characteristics and risk factors associated with disease severity, unimprovement and mortality are unclear.

          Methods

          All consecutive patients diagnosed with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 11 to February 6, 2020 were enrolled in this retrospective cohort study.

          Results

          A total of 663 COVID-19 patients were included in this study. Among those, 247 (37.3%) had at least one kind of chronic disease. A total of 0.5% (n=3) of patients were diagnosed with mild COVID-19, while 37.8% (251/663), 47.5% (315/663), and 14.2% (94/663) were in moderate, severe, and critical condition, respectively. In our hospital during follow-up, 251 of 663 (37.9%) patients were improved and 25 patients died, leading to a mortality rate of 3.77%. Older patients (>60 years old) and those with chronic diseases were prone to have severe and critical COVID-19 conditions, show unimprovement, and die (P < 0.001, < 0.001). Multivariate logistic regression analysis identified being male (OR = 0.486, 95% CI 0.311-0.758; P = 0.001), having severe COVID-19 conditions (OR = 0.129, 95% CI 0.082-0.201; P < 0.001), expectoration (OR = 1.796, 95% CI 1.062-3.036; P = 0.029), muscle ache (OR = 0.309, 95% CI 0.153-0.626; P = 0.001), and decreased albumin (OR = 1.929, 95% CI 1.199-3.104; P = 0.007) were associated with unimprovement in COVID-19 patients.

          Conclusion

          Being male, in severe COVID-19 conditions, expectoration, muscle ache, and decreased albumin were independent risk factors which influence the improvement of COVID-19 patients.

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          Most cited references6

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          Clinical Characteristics of Coronavirus Disease 2019 in China

          Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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            Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

            In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
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              KDIGO Clinical Practice Guidelines for Acute Kidney Injury

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                Author and article information

                Contributors
                Journal
                Clin Microbiol Infect
                Clin. Microbiol. Infect
                Clinical Microbiology and Infection
                European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd.
                1198-743X
                1469-0691
                15 April 2020
                15 April 2020
                Affiliations
                [1 ]Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
                [2 ]Department of Plastic surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
                [3 ]Department of Respirology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
                [4 ]Department of Emergency, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
                [5 ]Department of Infectious disease, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
                [6 ]Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
                [7 ]Department of Oncology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
                [8 ]Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
                [9 ]Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
                [10 ]Department of Otorhinolaryngology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
                [11 ]Department of Neurology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
                Author notes
                []Corresponding author. dwg@ 123456whu.edu.cn
                [∗∗ ]Corresponding author. xy37138@ 123456163.com
                [∗∗∗ ]Tel.: +86 27-88041911; fax: +86 27-880422292. wgh6402@ 123456163.com
                [#]

                Jixiang Zhang and Xiaoli Wang contributed equally to this work.

                Article
                S1198-743X(20)30217-2
                10.1016/j.cmi.2020.04.012
                7159868
                32304745
                6c30d183-db68-4ab0-9c85-1ca85f6af03d
                © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 25 February 2020
                : 7 April 2020
                : 12 April 2020
                Categories
                Article

                Microbiology & Virology
                Microbiology & Virology

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