Background: Around the globe, moderate cases account for the largest proportion of all coronavirus disease 2019 (COVID-19) patients, and deteriorated moderate patients contribute the most in mortality. However, published articles failed to address the deterioration details of moderate cases, especially on when and how they deteriorated. Methods: All moderate COVID-19 patients hospitalized in Guangdong Province from January 14 to March 16, 2020, were included in this multicenter retrospective cohort study and were divided into deteriorated and non-deteriorated groups according to clinical status. Symptoms and demographic, therapeutic, and laboratory test result characteristics were collected to explore the features of disease deterioration. Results: Of 1,168 moderate patients included, 148 (13%) deteriorated to severe (130 cases) or critical (18 cases) status. Over 20% of the older subgroup (>50 years old) showed deterioration. The median time for deterioration was 11 days after onset [interquartile range (IQR) 9–14 days]. In addition, 12.2% severe cases could further develop to critical status after 3 days (IQR 2–6.5 days) of having a severe condition. Respiratory dysfunction and hypoxia were the major manifestations as disease deterioration, while 76 cases (52.1%) showed respiratory rate >30 breaths/min, 119 cases (80.4%) showed SaO 2 <93%, 100 cases (67.5%) had 201 < PaO 2 /FiO 2 < 300, and 27 cases (18.9%) had blood lactic acid >2.0 mmol/L. In view of multiple organ dysfunction, 87.8% of acute respiratory distress syndrome (ARDS), 20.2% of acute kidney injury (AKI), 6.8% of coagulopathy, 4% of acute heart failure (AHF), 3.4% of acute hepatic injury (AHI), and 5.4% of shock occurred in deteriorated patients, while organ injury occurred in the following sequence: ARDS, AKI, AHF, coagulopathy, AHI, and shock. Conclusions: The deteriorated pattern of moderate COVID-19 patients is characterized as the 11th day from onset (IQR 9–14 days) being an important time point of disease deterioration with further exacerbation to critical condition in 3 days (IQR 2–6.5 days), A RDS followed by AKI being the typical modes of sequential organ damage.
【저자키워드】 COVID-19, Deterioration, pattern, moderate, time point, 【초록키워드】 coronavirus disease, ARDS, Mortality, hypoxia, Acute kidney injury, Moderate COVID-19, Laboratory, Coagulopathy, clinical status, Acute heart failure, Shock, AKI, Characteristics, therapeutic, Patient, multicenter, respiratory, group, Critical, patients, multiple organ dysfunction, Blood, acute respiratory distress, manifestation, respiratory rate, dysfunction, retrospective cohort study, Older, lactic acid, median time, syndrome, organ injury, Severe case, critical condition, organ damage, article, hepatic injury, Guangdong, over, feature, collected, develop, occurred, globe, proportion, addition, characterized, contribute, disease deterioration, IQR, PaO, patients hospitalized, 【제목키워드】 China,