Risk of severe case in COVID-19 patients and Azvudine: A Retrospective cohort study after exit from 'zero-COVID' policy
Dr Lishan Li, Lihua Ye, Baijie Lu, Jieling Wang, Guanhua Wei, Dr. Zhuang Bian
Background: COVID-19 leaded to significant morbidity and mortality. To investigate contributing factors to severity and examine whether Azvudine can reduce mortality, we conducted a single-center, retrospective cohort study. Method: 4201 COVID-19 patients discharged from our hospital were enrolled. Logistic regression analysis and ROC curve were used to investigate the role of comorbidities, laboratory parameters and clinical manifestation on progression of COVID-19. Propensity-score models conditional on baseline characteristics and Univariate Cox regression model were used to examine whether Azvudine can reduce the mortality of COVID-19. Result: Age, male sex, cerebrovascular disease, chronic kidney disease, liver disease, tumor and chronic lung disease were associated with elevated risk of mortality and chronic kidney disease contributed the most risk. Uric acid showed a U-shape risk of severity. Both hyperuricemia and hypouricemia increased the risk of severity. D-dimer，NT-BNP, LDH and FT3 were the most sensitive and specific markers for the prediction of mortality. Poor appetite, consciousness deterioration, polypnea and persistent high fever were associated with elevated risk of severity. Compared with no antiviral group, Azvudine can reduce the COVID-19 mortality (hazard ratio 0.708(95% confidence interval 0.516 to 0.971), P=0.032. There was no significant difference in mortality reduction between Molnupiravir and Azvudine(P=0.486). Conclusions: Among COVID-19 patients, age, male sex and comorbidities can affect progression of COVID-19. D-dimer ， NT-BNP, LDH, FT3, UA, poor appetite, consciousness deterioration, polypnea and persistent high fever can help doctors predict severe illness. Azvudine is neck and neck with Molnupiravir in the mortality reduction among COIVD-19.
Authors' contributions All authors participated in the design of the study. Zhuang Bian performed the statistical analysis. Lishan Li was the major contributor in writing the manuscript. All authors read and approved the final manuscript. Ethical approval and consent to participate The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Ethics Committee of the Fifth Affiliated Hospital of Sun Yat-sen University ([2023] K171-1). Informed consent waiver with Institutional Ethics Committee of the Fifth Affiliated Hospital of Sun Yat-sen University.
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Competing interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Figure Figure Figure Figure Figure Figure Figure Figure Figure Figure Figure Supplementary Files
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