Factors Associated with ARDS in COVID-19 Identified

Patients with severe illness may develop dyspnea and hypoxemia within one week after onset of the disease, which may quickly progress to acute respiratory distress syndrome (ARDS) or end-organ failure. The clinical characteristics and factors associated with developing ARDS after hospital admission and progression from ARDS to death in patients with COVID-19 pneumonia.

A team of medical scientists collaborating with Zhongshan Hospital (Shanghai, China) carried out a retrospective cohort study of 201 patients aged 21 to 83 years with confirmed COVID-19 pneumonia hospitalized at Jinyintan Hospital in Wuhan, China. To identify SARS-CoV-2 infection, throat swab samples were obtained from all patients at admission and tested using real-time reverse transcriptase–polymerase chain reaction assays. Additionally, patients underwent blood routine blood test, coagulation, and biochemical tests and chest x-rays or computed tomography.

The most commonly self-reported symptoms at onset included fever (93.5%), cough (81.1%), productive cough (41.3%), dyspnea (39.8%) and fatigue or myalgia (32.3%). Approximately three-quarters presented with fever and cough, more than one-third presented with fever and dyspnea, approximately one-third presented with fever and fatigue, myalgia or headache and only 6.5% presented with fever alone. At last follow-up, 71.6% of patients were discharged from the hospital. Of the 41.8% patients who developed ARDS during the study, slightly more than half died.

The team reported that of 194 patients, 166 (85.6%) demonstrated increased high-sensitivity C-reactive protein. More than half (126/197 [64.0%]) of this cohort had lymphocytopenia. About one-third (68/197 [34.5%]) of patients had neutrophilia. Approximately one-quarter (46/197 [23.4%]) of patients had leukocytosis. Some patients demonstrated liver injury with elevated aspartate aminotransferase (AST; 59/198 [29.8%]) and alanine aminotransferase (ALT; 43/198 [21.7%]). Most patients presented with an elevated myocardial indices: 194/198 (98.0%) had elevated lactate dehydrogenase (LDH) and 9/198 (4.5%) had an elevated creatine kinase muscle-brain isoform. Few patients had kidney injury indicated by elevated plasma urea (9/198 [4.5%]) and serum creatinine (9/198 [4.5%]). Of 195 patients, four (2.1%) presented with prolonged prothrombin times (PTs). The team noted that interleukin-6 (IL-6) was statistically significantly associated with death.

The authors wrote that their findings suggest that for patients with COVID-19 pneumonia, methylprednisolone treatment may be beneficial for those who have developed ARDS on disease progression. The study was published on March 13, 2020 in the journal JAMA Internal Medicine.

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