Risk Factors for ARDS and Progression to Death Among COVID-19 Patients

Patients with COVID-19 are at risk for acute respiratory distress syndrome (ARDS) and death from respiratory failure. Age and medical comorbidities have been consistently described as risk factors for poor outcomes. In an additional cohort of hospitalized patients from China, investigators now describe risk factors for ARDS, death during hospitalization, and the effect of treatment of ARDS with methylprednisolone.

The study group consisted of 201 patients with confirmed COVID-19 admitted to a single hospital in Wuhan from December 25, 2019, to January 26, 2020. Median age was 51 years (interquartile range, 43–60 years); 63.7% were male, and 32.8% had comorbidities. Median hospital stay was 13 days (IQR, 10–16 days), 33% required mechanical ventilation, and median time from admission to ARDS was 2 days (IQR, 1–4 days). Although the numbers of patients tested varied, laboratory abnormalities were common, including elevated lactate dehydrogenase in 194 (98%), elevated high-sensitivity C-reactive protein in 166 (85.6%), elevated interleukin-6 in 60 (48.8%), and elevated D-dimer in 44 (23.3%). Age ≥65 years, neutrophilia, and organ or coagulation dysfunction were associated with ARDS and death. Among those with ARDS, treatment with methylprednisolone was associated with significantly better outcomes: 23 of 50 (46%) methylprednisolone recipients died compared with 21 of 34 (61.8%) nonrecipients (hazard ratio, 0.38).