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Clinical and Laboratory Factors Predicting the Prognosis of Patients with COVID-19: An Analysis of 127 Patients in Wuhan, China

BACKGROUND: Corona virus infective disease 2019(COVID-19) is an emerging infectious disease that first outbreak in humans in China in December 2020 and has subsequently spread worldwide. This study aimed to describe and evaluate the clinical and laboratory indexes to predict the outcome of COVID-19. 
 
METHODS: Consecutive patients with confirmed COVID-19 admitted to Jinyintan hospitals in Wuhan, China were included from December 26 to January31 2020. All patients had definite clinical outcome (discharge or death) before February 10. The area under the receiver operating characteristic curve (AUC) of subjects was used to evaluate the prediction efficiency of laboratory parameters. Multiple logistic regression was used to evaluate the independent prognostic factors. 
 
FINDINGS: The study included 127 hospitalized patients with confirmed COVID-19, with 91 cured and 36 died patients. The most common complications of COVID-19 death were acute cardiac injury (21 patients, 58.3%), ARDS (20 patients, 55.6%), coagulation dysfunction (14 patients, 38.9%), and acute kidney injury (12 patients, 33.3%). Died patients was more likely to have multiple organ dysfunction syndrome (p<0.001). The died patients had deteriorated at-admission liver and kidney function, tissue damage related biomarkers (lactate dehydrogenase, creatine kinase and troponin I) , prolonged prothrombin time. The inflammatory biomarkers, including c-reactive protein, ferritin, procalcitonin and interleukin-6 (IL-6) levels also significantly increased. The area under the receiver operating characteristic curve (AUC) showed that at-admission CD3 positive-, CD4 positive- and CD8 positive- lymphocyte counts had good prognostic values for clinical outcomes (AUC=0.915, 0.886 and 0.870, respectively) while lymphocyte counts in blood routine test was moderate (AUC=0.732). Moreover, the prognostic values of lactate dehydrogenase, troponin I, prothrombin time, and procalcitonin were good (AUC=0.928, =0.939, =0.920, and =0.900, respectively. Multiple regression model showed that CD3+ lymphocyte counting ≤470/ µl, prothrombin time≥13.5 s and procalcitonin≥0.15 ng/ml were independent prognostic factors for death. 
 
INTERPRETATION: The predictive effect of CD3+ lymphocyte typing count on the clinical outcome of COVID-19 was better than that of routine lymphocyte count. Elevated at-admission procalcitonin and prothrombin time were independent prognostic factors for death. 
 
FUNDING STATEMENT: Urgent projects of scientific and technological research on COVID funded by Hubei province 
 
DECLARATION OF INTERESTS: The authors declare no competing interests. 
 
ETHICS APPROVAL STATEMENT: This study was approved by the Institutional Ethics Board of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology and Jinyintan Hospital.