A Comprehensive Evaluation of Early Predictors of Disease Progression in Patients with COVID-19: A Case Control Study

Abstract Background: The 2019 coronavirus disease (COVID-19) has become an unprecedented public health crisis with nearly 16 million confirmed cases and 630,000 deaths worldwide. Methods: We retrospectively investigated the demographic, clinical, laboratory, radiological and treatment data of COVID-19 patients consecutively enrolled from January 18 to May 15, 2020, in Taihe and Jinzhou central hospital. Results: Of all 197 patients, the median age was 66.5 years (IQR 7-76), and 120 (60.9%) patients were males. We identified 88 (44.7%) of 197 COVID-19 patients as the disease progression (aggravation) cases. The aggravation cases tend to have more medical comorbidity: hypertension (34.1%), diabetes (30.7%), and presented with dyspnea (34.1%), neutrophilia (60.2%), and lymphocytopenia (73.9%), compared with those without. And the patients with disease progression showed significantly higher level of Fibrinogen (Fbg), D-dimer, IL-6, C-reactive protein (CRP), procalcitonin (PCT), and serum ferritin, and were more prone to develop organ damage in the liver, kidney, and heart (P<0.05). Multivariable regression showed that advanced age, comorbidities, lymphopenia, and elevated level of Fbg, lactate dehydrogenase (LDH), Cardiac troponin (CTnI), IL-6, serum ferritin were the significant predictors of disease progression. Further, we investigated antibody responses to SARS-CoV-2 and found that the levels of IgM and IgG were significantly higher in the disease progression cases compared to non-progression cases from 3 weeks after symptom onset. In addition, the disease progression group tended to peak later and has a more vigorous IgM/IgG response against SARS-CoV-2. Further, we performed Kaplan-Meier analysis and found that 61.6% of patients had not experienced ICU transfer or survival from hospital within 25 days from admission.Conclusions: Investigating the potential factors of advanced age, comorbidities and elevated level of IL-6, serum ferritin and Kaplan-Meier analysis enables early identification and management of patients with poor prognosis. Detection of the dynamic antibody may offer vital clinical information during the course of SARS-CoV-2 and provide prognostic value for patients infection.