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Risk factors associated with acute respiratory distress syndrome and death in patients with Coronavirus disease 2019 pneumonia in Wuhan, China

Our take —

This study demonstrated a strong risk gradient for acute respiratory distress syndrome and death with age among patients with severe disease. Results may not be generalizable to patients with less severe disease. Several other risk factors were identified, however analyses were unadjusted and should be interpreted with caution. Patients receiving methylprednisolone were less likely to die; however, potential selection biases cannot be ruled out. This finding should be interpreted with caution and confirmed with future randomized clinical trials.

Study design

Case Series

Study population and setting

Jinyintan Hospital in Wuhan, China. Patients were admitted from December 25, 2019 to January 26, 2020. Clinical data were obtained through electronic medical record review, with follow-up through February 13, 2020. The study enrolled 201 patients aged 21 to 83 (median, 51 years) with confirmed COVID-19 pneumonia; 64% male.

Summary of Main Findings

Eighty-four patients (41.8%) developed acute respiratory distress syndrome (ARDS), and of those 84, 44 (52.4%) died. High fever was associated with higher risk of ARDS development but a lower likelihood of death. Risk factors associated with the development of ARDS and progression from ARDS to death included older age, neutrophilia, and organ and coagulation dysfunction (e.g. higher lactate dehydrogenase and D-Dimer concentrations). Treatment with methylprednisolone may be beneficial for patients who develop ARDS.

Study Strengths

The study provides a more detailed description of the epidemiological, clinical, and outcomes data associated with COVID-19 disease from a relatively larger sample of individuals with confirmed COVID-19 pneumonia hospitalized in Wuhan, China. The study identified factors associated with poor clinical outcomes and death in unadjusted analyses.

Limitations

This was a relatively small sample from a single-center hospital and included only patients with COVID-19 pneumonia. As such, this study may relate only to those characteristics that are associated with severe disease. Analyses were unadjusted for potential confounders. Potential confounding by indication may have biased the findings that methylprednisolone treatment was associated with risk of ARDS; however, it appeared to reduce the risk of death among those who did receive it; larger controlled or practical trials are necessary to determine its effectiveness.

Value added

This is one of the first studies to provide a more detailed characterization of the epidemiological and clinical characteristics associated with poor clinical outcomes among confirmed COVID-19 pneumonia patients in Wuhan, China.