Early Clinical Factors Predicting the Development of Critical Disease in Japanese Patients with COVID-19: A Single-Center Retrospective, Observational Study

Higuchi, T.; Nishida, T.; Iwahashi, H.; Morimura, O.; Otani, Y.; Okauchi, Y.; Yokoe, M.; Suzuki, N.; Inada, M.; Abe, K.

Background: Insufficient evidence of factors predicting the COVID-19 progression from mild to moderate to critical has been established. We retrospectively evaluated risk factors for critical progression in Japanese COVID-19 patients. Method: Seventy-four laboratory-confirmed COVID-19 patients were hospitalized in our hospital between February 20, 2020, and June 10, 2020. We excluded asymptomatic, non-Japanese, and child patients. We divided patients into the stable group (SG) and the progression group (PG) (patients requiring mechanical ventilation). We compared the clinical factors in both groups. We established the cutoff values (COVs) for significantly different factors via receiver operating characteristic (ROC) curve analysis and evaluated risk factors by univariate regression. Results: We enrolled 57 COVID-19 patients (median age 52 years, 56.1% male). The median progression time from symptom onset was eight days. Seven patients developed critical disease (PG: 12.2%), two (3.5%) of whom died; 50 had stable disease. Univariate logistic analysis identified elevated lactate dehydrogenase (LDH) (COV: 309 U/l), decreased estimated glomerular filtration rate (eGFR) (COV: 68 ml/min), lymphocytopenia (COV: 980/l), and statin use as significantly associated with disease progression. However, in Cox proportional hazards analysis, lymphocytopenia at symptom onset was not significant. Conclusions: We identified three candidate risk factors for adult Japanese patients with mild to moderate COVID-19: statin use, elevated LDH level, and decreased eGFR.