• Jichan Shi, Yang Li, Xian Zhou, Qiran Zhang, Xinchun Ye, Zhengxing Wu, Xiangao Jiang, Hongying Yu, Lingyun Shao, Jing-Wen Ai, Haocheng Zhang, Bin Xu, Feng Sun, and Wenhong Zhang.
• Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, 325000, China.
• Bmc Med. 2020 Jun 3; 18 (1): 168.

BackgroundCoronavirus disease 2019 (COVID-19) has infected more than 4 million people within 4 months. There is an urgent need to properly identify high-risk cases that are more likely to deteriorate even if they present mild diseases on admission.MethodsA multicenter nested case-control study was conducted in four designated hospitals in China enrolling confirmed COVID-19 patients who were mild on admission. Baseline clinical characteristics were compared between patients with stable mild illness (stable mild group) and those who deteriorated from mild to severe illness (progression group).ResultsFrom Jan 17, 2020, to Feb 1, 2020, 85 confirmed COVID-19 patients were enrolled, including 16 in the progression group and 69 in the stable mild group. Compared to stable mild group (n = 69), patients in the progression group (n = 16) were more likely to be older, male, presented with dyspnea, with hypertension, and with higher levels of lactase dehydrogenase and c-reactive protein. In multivariate logistic regression analysis, advanced age (odds ratio [OR], 1.012; 95% confidence interval [CI], 1.020-1.166; P = 0.011) and the higher level of lactase dehydrogenase (OR, 1.012; 95% CI, 1.001-1.024; P = 0.038) were independently associated with exacerbation in mild COVID-19 patients.ConclusionAdvanced age and high LDH level are independent risk factors for exacerbation in mild COVID-19 patients. Among the mild patients, clinicians should pay more attention to the elderly patients or those with high LDH levels.

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