Longitudinal trajectories of pneumonia lesions and lymphocyte counts associated with disease severity among convalescent COVID-19 patients: a group-based multi-trajectory analysis

BMC Pulmonary Medicine

Nannan Shi¹  Qinguo Hou¹  Fengjun Liu¹  Yuxin Shi¹  Chunzi Shi¹  Jie Shen¹  Fei Shan¹  Fengxiang Song¹  Zhiyong Zhang²  Xiaoming Su³  Lei Shi⁴  Cheng Liu⁴  Chao Huang⁴  Qi Zhang⁵ 

[1] Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, 201508, Shanghai, China;Fudan University, Shanghai, China;Institute of Healthcare Research, Yizhi, Shanghai, China;Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, 200051, Shanghai, China;Institute of Healthcare Research, Yizhi, Shanghai, China;Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, 200051, Shanghai, China;Institute of Healthcare Research, Yizhi, Shanghai, China;Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China;School of Communication and Information Engineering, Shanghai University, Shanghai, China;

关键词: COVID-19;    Group-based multi-trajectory modelling;    Clinical course;    Pneumonia;    Lymphocyte;   

DOI  :  10.1186/s12890-021-01592-6

来源: Springer

【 摘 要 】

BackgroundTo explore the long-term trajectories considering pneumonia volumes and lymphocyte counts with individual data in COVID-19.MethodsA cohort of 257 convalescent COVID-19 patients (131 male and 126 females) were included. Group-based multi-trajectory modelling was applied to identify different trajectories in terms of pneumonia lesion percentage and lymphocyte counts covering the time from onset to post-discharge follow-ups. We studied the basic characteristics and disease severity associated with the trajectories.ResultsWe characterised four distinct trajectory subgroups. (1) Group 1 (13.9%), pneumonia increased until a peak lesion percentage of 1.9% (IQR 0.7–4.4) before absorption. The slightly decreased lymphocyte rapidly recovered to the top half of the normal range. (2) Group 2 (44.7%), the peak lesion percentage was 7.2% (IQR 3.2–12.7). The abnormal lymphocyte count restored to normal soon. (3) Group 3 (26.0%), the peak lesion percentage reached 14.2% (IQR 8.5–19.8). The lymphocytes continuously dropped to 0.75 × 109/L after one day post-onset before slowly recovering. (4) Group 4 (15.4%), the peak lesion percentage reached 41.4% (IQR 34.8–47.9), much higher than other groups. Lymphopenia was aggravated until the lymphocytes declined to 0.80 × 109/L on the fourth day and slowly recovered later. Patients in the higher order groups were older and more likely to have hypertension and diabetes (all P values < 0.05), and have more severe disease.ConclusionsOur findings provide new insights to understand the heterogeneous natural courses of COVID-19 patients and the associations of distinct trajectories with disease severity, which is essential to improve the early risk assessment, patient monitoring, and follow-up schedule.

【 授权许可】

CC BY