The clinical warning index of severe COVID-19: discussion based on the clinical features and outcomes of 4 patients.

Song, Y-S; Hao, Y-B; Liu, H-T; Li, L-H; Yang, Z-Z; Liu, W-W; Liu, Q; Zhang, S-S; Fan, T-L

OBJECTIVE Coronavirus disease 2019 (COVID-19) is spreading worldwide. The onset of severe COVID-19 could lead to multiple organ damage and even death. It is worth paying attention to the warning index of the onset for severe COVID-19 so that patients can be identified and monitored carefully. PATIENTS AND METHODS The report is a retrospective study that describes and analyzes the clinical features during the treatment of COVID-19. Four patients with COVID-19 were involved in this study, who were father-and-son pairs from two families. All patients were treated with the same combination of anti-microbial and anti-viral agents for 10-14 days, adjusting for the disease status. The primary outcome measure was SARS-CoV-2 detection using RT-qPCR with oropharyngeal swabs. Chest CT imaging served as a secondary outcome measure. RESULTS One of the four patients progressed to severe disease, while the remaining patients recovered with the same treatment. A persistent decrease in the lymphocyte ratio and increase in the C-reactive protein (CRP) level were observed in the severe patient, along with other typical symptoms of COVID-19. CONCLUSIONS The cases we described indicate that blood cell and CRP tests could be useful risk warnings of severe onset of COVID-19.