ARDS in COVID-19 less likely with younger age, normal BP

  • Wu C & al.
  • JAMA Intern Med
  • 13 Mar 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • In this single-center study of patients with COVID-19 pneumonia, risk factors for acute respiratory distress syndrome (ARDS) and death included older age, organ dysfunction.  

Why this matters

  • These data could aid in prognostication and disposition decision-making.

Key results

  • Median age, 51 years; 63.7% men.
  • 82.1% required oxygen.
  • 41.8% (n=84) developed ARDS, of whom 52.4% (n=44) died.
  • Factors associated with ARDS:
    • Older age: difference, 12.0 years (P<.001>
    • Higher baseline temperature: difference, 0.30°C (P=.004).
    • More dyspnea: difference, 33.9% (P<.001>
    • More hypertension: difference, 13.7% (P=.02).
    • More diabetes: difference, 13.9% (P=.002).
    • Less receipt of antivirals: difference, −14.4% (P=.005).
    • More receipt of methylprednisolone: difference, 49.3% (P<.001>
    • Higher neutrophil counts; biomarkers of organ damage, inflammation, and coagulopathy; lower lymphocyte counts.
  • Patients who died vs survived were:
    • Older: difference, 18.0 years (P<.001 class=""> 
    • Found to have lower rates of high fever: difference, −31.8% (P=.007).
    • Likelier to have hypertension: difference, 18.9% (P=.05).
    • Less likely to receive antivirals: difference, −40.7% (P<.001>

Study design

  • Retrospective single-center cohort study of adults with COVID-19 pneumonia in Wuhan, China (n=201).
  • Outcomes: risk factors for ARDS, death.
  • Funding: Chinese university, government funders.

Limitations

  • Steroid finding potentially due to confounding by indication.