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Showing content from https://pubmed.ncbi.nlm.nih.gov/32167524/ below:

Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

. 2020 Jul 1;180(7):934-943. doi: 10.1001/jamainternmed.2020.0994. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China Chaomin Wu^{1 2 3}, Yanping Cai², Jia'an Xia⁴, Xing Zhou², Sha Xu², Hanping Huang⁴, Li Zhang⁴, Xia Zhou⁴, Chunling Du¹, Yuye Zhang³, Juan Song³, Sijiao Wang³, Yencheng Chao³, Zeyong Yang⁵, Jie Xu⁶, Xin Zhou⁷, Dechang Chen⁸, Weining Xiong⁹, Lei Xu¹⁰, Feng Zhou¹, Jinjun Jiang³, Chunxue Bai^{3 11}, Junhua Zheng¹², Yuanlin Song^{1 3 11 13}

Affiliations

¹ Department of Pulmonary Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.
² Infection Division, Wuhan Jinyintan Hospital, Wuhan, China.
³ Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
⁴ Tuberculosis and Respiratory Department, Wuhan Jinyintan Hospital, Wuhan, China.
⁵ Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁶ Department of Infectious Diseases, Fengxian Guhua Hospital, Shanghai, China.
⁷ Department of Pulmonary Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁸ Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁹ Department of Respiratory Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹⁰ Department of Emergency Medicine, Shanghai Pudong New Area Gongli Hospital, Shanghai, China.
¹¹ Shanghai Respiratory Research Institute, Shanghai, China.
¹² Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹³ National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.

PMID: 32167524
PMCID: PMC7070509
DOI: 10.1001/jamainternmed.2020.0994

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Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

Chaomin Wu et al. JAMA Intern Med. 2020.

. 2020 Jul 1;180(7):934-943. doi: 10.1001/jamainternmed.2020.0994. Authors Chaomin Wu^{1 2 3}, Xiaoyan Chen³, Yanping Cai², Jia'an Xia⁴, Xing Zhou², Sha Xu², Hanping Huang⁴, Li Zhang⁴, Xia Zhou⁴, Chunling Du¹, Yuye Zhang³, Juan Song³, Sijiao Wang³, Yencheng Chao³, Zeyong Yang⁵, Jie Xu⁶, Xin Zhou⁷, Dechang Chen⁸, Weining Xiong⁹, Lei Xu¹⁰, Feng Zhou¹, Jinjun Jiang³, Chunxue Bai^{3 11}, Junhua Zheng¹², Yuanlin Song^{1 3 11 13} Affiliations

¹ Department of Pulmonary Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.
² Infection Division, Wuhan Jinyintan Hospital, Wuhan, China.
³ Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
⁴ Tuberculosis and Respiratory Department, Wuhan Jinyintan Hospital, Wuhan, China.
⁵ Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁶ Department of Infectious Diseases, Fengxian Guhua Hospital, Shanghai, China.
⁷ Department of Pulmonary Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁸ Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁹ Department of Respiratory Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹⁰ Department of Emergency Medicine, Shanghai Pudong New Area Gongli Hospital, Shanghai, China.
¹¹ Shanghai Respiratory Research Institute, Shanghai, China.
¹² Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹³ National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.

PMID: 32167524
PMCID: PMC7070509
DOI: 10.1001/jamainternmed.2020.0994

Item in Clipboard

Erratum in

Errors in Data and Units of Measure.
[No authors listed] [No authors listed] JAMA Intern Med. 2020 Jul 1;180(7):1031. doi: 10.1001/jamainternmed.2020.1429. JAMA Intern Med. 2020. PMID: 32391849 Free PMC article. No abstract available.

Abstract

Importance: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Risk factors for the clinical outcomes of COVID-19 pneumonia have not yet been well delineated.

Objective: To describe the clinical characteristics and outcomes in patients with COVID-19 pneumonia who developed acute respiratory distress syndrome (ARDS) or died.

Design, setting, and participants: Retrospective cohort study of 201 patients with confirmed COVID-19 pneumonia admitted to Wuhan Jinyintan Hospital in China between December 25, 2019, and January 26, 2020. The final date of follow-up was February 13, 2020.

Exposures: Confirmed COVID-19 pneumonia.

Main outcomes and measures: The development of ARDS and death. Epidemiological, demographic, clinical, laboratory, management, treatment, and outcome data were also collected and analyzed.

Results: Of 201 patients, the median age was 51 years (interquartile range, 43-60 years), and 128 (63.7%) patients were men. Eighty-four patients (41.8%) developed ARDS, and of those 84 patients, 44 (52.4%) died. In those who developed ARDS, compared with those who did not, more patients presented with dyspnea (50 of 84 [59.5%] patients and 30 of 117 [25.6%] patients, respectively [difference, 33.9%; 95% CI, 19.7%-48.1%]) and had comorbidities such as hypertension (23 of 84 [27.4%] patients and 16 of 117 [13.7%] patients, respectively [difference, 13.7%; 95% CI, 1.3%-26.1%]) and diabetes (16 of 84 [19.0%] patients and 6 of 117 [5.1%] patients, respectively [difference, 13.9%; 95% CI, 3.6%-24.2%]). In bivariate Cox regression analysis, risk factors associated with the development of ARDS and progression from ARDS to death included older age (hazard ratio [HR], 3.26; 95% CI 2.08-5.11; and HR, 6.17; 95% CI, 3.26-11.67, respectively), neutrophilia (HR, 1.14; 95% CI, 1.09-1.19; and HR, 1.08; 95% CI, 1.01-1.17, respectively), and organ and coagulation dysfunction (eg, higher lactate dehydrogenase [HR, 1.61; 95% CI, 1.44-1.79; and HR, 1.30; 95% CI, 1.11-1.52, respectively] and D-dimer [HR, 1.03; 95% CI, 1.01-1.04; and HR, 1.02; 95% CI, 1.01-1.04, respectively]). High fever (≥39 °C) was associated with higher likelihood of ARDS development (HR, 1.77; 95% CI, 1.11-2.84) and lower likelihood of death (HR, 0.41; 95% CI, 0.21-0.82). Among patients with ARDS, treatment with methylprednisolone decreased the risk of death (HR, 0.38; 95% CI, 0.20-0.72).

Conclusions and relevance: Older age was associated with greater risk of development of ARDS and death likely owing to less rigorous immune response. Although high fever was associated with the development of ARDS, it was also associated with better outcomes among patients with ARDS. Moreover, treatment with methylprednisolone may be beneficial for patients who develop ARDS.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures
Figure.. Survival Curve in Patients With Acute…

Figure.. Survival Curve in Patients With Acute Respiratory Distress Syndrome Who Did and Did Not…
Figure.. Survival Curve in Patients With Acute Respiratory Distress Syndrome Who Did and Did Not Receive Methylprednisolone Treatment

Administration of methylprednisolone reduced the risk of death (hazard ratio, 0.38; 95% CI, 0.20-0.72; P = .003).

Comment in

A retrospective cohort study of methylprednisolone therapy in severe patients with COVID-19 pneumonia.
Wang Y, Jiang W, He Q, Wang C, Wang B, Zhou P, Dong N, Tong Q. Wang Y, et al. Signal Transduct Target Ther. 2020 Apr 28;5(1):57. doi: 10.1038/s41392-020-0158-2. Signal Transduct Target Ther. 2020. PMID: 32341331 Free PMC article. No abstract available.
Errors in Units of Measure and Reference Value for Laboratory Tests and Numbers of Patients in Study of COVID-19 in Wuhan, China.
Song Y, Zheng J. Song Y, et al. JAMA Intern Med. 2020 Jul 1;180(7):1028-1029. doi: 10.1001/jamainternmed.2020.1576. JAMA Intern Med. 2020. PMID: 32391856 No abstract available.
Methylprednisolone added to tocilizumab reduces mortality in SARS-CoV-2 pneumonia: An observational study.
Sanz Herrero F, Puchades Gimeno F, Ortega García P, Ferrer Gómez C, Ocete Mochón MD, García Deltoro M. Sanz Herrero F, et al. J Intern Med. 2021 Feb;289(2):259-263. doi: 10.1111/joim.13145. Epub 2020 Jul 17. J Intern Med. 2021. PMID: 32603493 Free PMC article. No abstract available.
The Uncertain Role of Corticosteroids in the Treatment of COVID-19.
Ellsworth GB, Glesby MJ, Gulick RM. Ellsworth GB, et al. JAMA Intern Med. 2021 Jan 1;181(1):140. doi: 10.1001/jamainternmed.2020.2444. JAMA Intern Med. 2021. PMID: 32744591 No abstract available.
The Uncertain Role of Corticosteroids in the Treatment of COVID-19.
Liou TG, Adler FR, Hatton ND. Liou TG, et al. JAMA Intern Med. 2021 Jan 1;181(1):139-140. doi: 10.1001/jamainternmed.2020.2438. JAMA Intern Med. 2021. PMID: 32744622 Free PMC article. No abstract available.
Clinical Laboratory Test Unit Homogeneity-an Urgent Need.
Mussap M. Mussap M. JAMA Intern Med. 2020 Dec 1;180(12):1715-1716. doi: 10.1001/jamainternmed.2020.3532. JAMA Intern Med. 2020. PMID: 32955585 No abstract available.