COVID-19 progression influenced by age, timing of antiviral initiation

A retrospective study from China identified age, time between illness onset and antiviral initiation, and the presence of comorbidities as factors that increase the risk of COVID-19 progression.

The findings point to the importance of timely initiation of antiviral treatment and the management of comorbidities, particularly diabetes and cardiovascular disease, noted the researchers.

The researchers analysed the medical records of 280 patients (mean age 43.12 years) who were hospitalized for SARS-CoV-2 infection at four hospitals in China between 20 January and 19 February 2020. Chest radiography upon hospital admission showed that most patients had abnormal chest CT images (87.50 percent), with 43.57 and 43.93 percent having bilateral and unilateral pneumonia, respectively.

More than half the patients had moderate disease (52.86 percent), while 26.79 and 2.85 percent had severe and critical disease, respectively. Almost 30 percent of patients required intensive care unit (ICU) admission within a median 6 days of symptom onset, with a median stay of 18 days. Antiviral treatment was administered to all patients.

Multivariate analysis showed that older age (≥65 years) was a predictor of COVID-19 progression (odds ratio [OR], 81.20, 95 percent confidence interval [CI], 1.10–5988.12; p=0.045). [J Intern Med 2020;doi:10.1111/joim.13063]

The presence of comorbidities also raised the risk of COVID-19 progression (OR, 54.74, 95 percent CI, 1.14–2634.81; p=0.043), as did time to antiviral treatment initiation (OR, 26.98, 95 percent CI, 1.81–402.93; p=0.017).

The researchers noted that patients in the mild group (patients with mild and moderate disease) were younger than those in the severe group (patients with severe and critical disease; median 37.55 vs 63.04 years), with fewer patients aged ≥65 years in the mild group (10.15 percent vs 59.04 percent; p<0.05). Imaging features at admission did not significantly differ between patients in the severe and mild groups (p=0.204). Creatine kinase (CK), CK-MB, C-reactive protein, and D-dimer levels were significantly higher in the severe vs the mild group, while white blood cell, lymphocyte, PaO₂, and PaO₂/FiO₂ levels were significantly lower in the severe group.

Most patients in the severe group had underlying comorbidities (82 out of 83 patients). Compared with the mild group, patients in the severe group were more likely to have cardiovascular and cerebrovascular disease (51.81 percent vs 7.11 percent; p=0.025) and endocrine disease (33.73 percent vs 3.05 percent; p=0.042). There was no significant between-group difference in the rates of respiratory, nervous, or digestive system disease or malignancy.

“[I]t is plausible that patients were more likely to develop myocardial infarction and heart failure when pneumonia coincide[d] with pre-existing cardiovascular problems,” said the researchers. “[B]lood glucose level may also play a pivotal role in the pathogenesis of infectious diseases.”

There were no deaths in this population. At time of study publication, 221 patients had been discharged. Among these patients, recovery was slower among patients in the severe compared with the mild group (18.70 vs 10.63 days; p<0.001), with comorbidity and time to antiviral treatment initiation affecting recovery time (p<0.001 for both).

“Our study [also] found that patients in the mild group experienced earlier initiation of antiviral treatment [1.19 vs 2.65 days among those in the severe group; p<0.001], indicating that early and timely antiviral treatment may significantly slow COVID-19 progression and improve the prognosis of patients,” the researchers concluded.