Key to successful treatment of COVID-19: accurate identification of severe risks and early intervention of disease progression

meizhu chen; changli tu; Cuiyan Tan; Xiaobin Zheng; xiaohua wang; jian wu; Yiying Huang; zhenguo wang; yan yan; zhonghe li; hong shan; Jing Liu; jin huang

The copyright holder for this preprint . https://doi.org/10.1101/2020.04.06.20054890 doi: medRxiv preprint significantly than that in non-severe cases. Shortness of breath was shown in all severe patients, which was 92% of ICU patients in the research of Huang et al [3] . A large scale multicenter research [12] of 1099 COVID-19 patients from 31 provinces reported 95.5%, 81.5% and 59.6% of severe cases had low lymphocyte count, high CRP and high D-dimer respectively, which were significant difference from non-severe ones. In the research of Huang [3] , low lymphocyte count, hypoalbuminemia and high D-dimer had been found common in severe COVID-19 patients, particularly in critical cases in ICU. In addition , we also found the hypokalemia and high BNP were more significant in severe cases than non-severe ones. In addition, SARS-CoV-2 viremia should also be paid attention to, as a predictor for progression to severe. Except for the abnormal values of above indicators, we found that it was more important to observe the changing trend of these indicators during course of disease. More significant low lymphocyte count and high CRP appeared in severe patients from the beginning and continued the whole course, which indicated the imbalance between early immune response and lateral inflammatory reaction. Liu [11] et al reported that mean days from illness onset to ICU admission were 8d in the severe or critical type. In our study, the peak of obvious abnormality of D-dimer and BNP appeared at day 8-9 of the disease course and then decreased slowly, which indicated early recognition of critical signs and the risk of secondary thrombosis and myocardial injury. The persistent hypoalbuminemia and hypokalemia suggested that the imbalance of homeostasis , at the same time instructed treatment. Some characteristic imaging findings, such as GGO, nodules, stripe and patchy consolidation , bronchial abnormalities, were consistent with previous studies [3, 12, 16] . The abnormal images on lung CT were corresponding to the pathological features of COVID-19 pneumonia [17] . Two types of acute exudative pathological changes had been considered corresponding to imaging change in these COVID-19