Early Prediction of Disease Progression in 2019 Novel Coronavirus Pneumonia Patients Outside Wuhan with CT and Clinical Characteristics

Zhichao Feng; Qizhi Yu; Shanhu Yao; Lei Luo; Junhong Duan; Zhimin Yan; Min Yang; Hongpei Tan; Mengtian Ma; Ting Li; Dali Yi; Ze Mi; Huafei Zhao; Yi Jiang; Zhenhu He; Huiling Li; Wei Nie; Yin Liu; Jing Zhao; Muqing Luo; Xuanhui Liu; Pengfei Rong; Wei Wang

lower than some large-scale reports. 3, 5 The main cause was because our patients were moderate on admission and enrolled from one single city. We found that progressive patients were older and had a greater number of underlying hypertension than stable patients. These data were in agreement with another recent report, which suggested that age and history of hypertension may be risk factors for short-term progression. 10 Our study further showed that progressive patients had lower baseline lymphocyte count, higher NLR and C-reactive protein. COVID-19 virus might act on lymphocytes as does severe acute respiratory syndrome coronavirus (SARS-CoV) which induces a cytokine storm and results in a series of immune responses. 11 Some studies suggest that decrease of T lymphocyte count indicate that coronavirus consumes many immune cells and inhibits the cellular immune function, and reduced but hyperactivated peripheral T cells partially accounts for the severe immune injury in COVID-19 patients. 12, 13 Thus, damage to lymphocytes might be an important factor leading to exacerbations of patients. NLR, as a simple lymphocyte related parameter to assess easily the inflammatory status, is widely used for the prediction of prognosis of patients with pneumonia. 14, 15 Higher NLR indicates damaged lymphocyte function and/or risk of bacterial infection due to low immune function. In addition, C-reactive protein is another serum maker produced by the liver in response to inflammation. Liu et al showed that C-reactive protein might be predictive of disease severity in COVID-19 infected patients. 16 Thus, our results suggested that patients with higher inflammatory levels on admission had higher risk to develop severe NCP.