Study identifies factors associated with ARDS in COVID-19

In a study from Wuhan, China, researchers found that certain factors, such as age or treatment with methylprednisolone, are associated with developing acute respiratory distress syndrome and its outcomes in patients with COVID-19, researchers reported in JAMA Internal Medicine.

The study included a cohort of 201 patients with confirmed COVID-19 pneumonia who were admitted to Wuhan Jinyintan Hospital in China from Dec. 25, 2019, to Jan. 26, 2020. Follow-up continued until Feb. 13. The median age of patients was 51 years and nearly two-thirds were men.

The most commonly self-reported symptoms at onset included fever (93.5%), cough (81.1%), productive cough (41.3%), dyspnea (39.8%) and fatigue or myalgia (32.3%). Approximately three-quarters presented with fever and cough, more than one-third presented with fever and dyspnea, approximately one-third presented with fever and fatigue, myalgia or headache and only 6.5% presented with fever alone. At last follow-up, 71.6% of patients were discharged from the hospital.

Of the 41.8% patients who developed ARDS during the study, slightly more than half died.

Results indicated that more patients who developed ARDS than those who did not presented with dyspnea (59.5% vs. 25.6%; P < .001) and had comorbidities such as hypertension (27.4% vs. 13.7%; P = .02) and diabetes (19% vs. 5.1%; P = .002). Further, patients who developed ARDS were less likely to be treated with antiviral therapy (P = .005) and more likely to be treated with methylprednisolone (P < .001).

Risk factors associated with both ARDS development and progression from ARDS to death included:

• older age (HR = 3.26; 95% CI, 2.08-5.11; and HR = 6.17; 95% CI, 3.26-11.67, respectively);

• neutrophilia (HR = 1.14; 95% CI, 1.09-1.19; and HR = 1.08; 95% CI, 1.01-1.17, respectively);

• organ and coagulation dysfunction such as higher lactate dehydrogenase (HR = 1.61; 95% CI, 1.44-1.79; and HR = 1.3; 95% CI, 1.11-1.52, respectively); and

• D-dimer (HR = 1.03; 95% CI, 1.01-1.04; HR = 1.02; 95% CI, 1.01-1.04, respectively).

The researchers noted that presentation with a fever of 39°C or higher was also linked to a higher likelihood for development of ARDS (HR = 1.77; 95% CI, 1.11-2.84) but a lower likelihood for death (HR = 0.41; 95% CI, 0.21-0.82). Additionally, risk for death also appeared lower among patients with ARDS who were treated with methylprednisolone (HR = 0.38; 95% CI, 0.2-0.72).

“These findings suggest that for patients with COVID-19 pneumonia, methylprednisolone treatment may be beneficial for those who have developed ARDS on disease progression,” the researchers wrote. “However, these results should be interpreted with caution owing to potential bias and residual confounding in this observational study with a small sample size. Double-blinded, randomized clinical trials should be conducted to validate these results.” – by Melissa Foster

Disclosures: The authors report no relevant financial disclosures.