Identification of risk factors for the severity of coronavirus disease 2019: a retrospective study of 163 hospitalized patients

Background: To compare clinical features between moderate and severe cases with COVID-19, and screen factors associated with disease severity. Methods: : Demographic and clinical data were compared between moderate and severe cases. Logistic regression was performed for prognostic factors. Results: : 163 patients (median age 65.0 (56.8-71.0) years, 78 (47.9%) females) were enrolled, including 87 (53.4%) severe and 76 (46.6%) moderate cases. 79 (90.8%) severe and 59 (77.6%) moderate cases had comorbidities, with hypertension and diabetes commonly presented. The most common symptoms were fever. Severe cases had higher lactate dehydrogenase (LDH), inflammatory cytokines and lymphopenia, eosinopenia on admission, and lower eosinophil and higher neutrophil counts from admission to day 13 and 19. Multivariable regression showed that neutrophilia, eosinopenia, high LDH and D-dimer were associated with severe COVID-19. In receiver operating characteristic curve analysis, LDH, eosinophil and neutrophil + eosinophil + LDH + D-dimer combination, with area under curve of 0.86, 0.76 and 0.93, predicted severe illness with high sensitivity (82.8%, 83.3%, 88.0%) and specificity (68.4%, 84.2%, 81.3%). Conclusions: : Eosinopenia, higher LDH and neutrophil + eosinophil + LDH + D-dimer combination on admission were powerful indicators of severe COVID-19. Dynamic changes of neutrophils and eosinophils may be used to evaluate disease progression.