Fibrosis Indicators May Signal Poor Prognosis Early in COVID-19 Course

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Coronavirus pneumonia
Fibrosis indicators, including lymphocyte count and C-reactive protein, may be used as early warning signs of poor prognosis in patients with COVID-19.

Pulmonary fibrosis indicators may be used as early warning signs of poor prognosis in patients with coronavirus disease 2019 (COVID-19), according to findings published in Respiratory Medicine.

Researchers retrospectively analyzed 32 patients who were admitted to Huangshi Traditional Chinese Medicine Hospital in Hubei, China, in between January 1, 2020, and March 20, 2020. Patients whose chest computed tomography did not exhibit characteristic pneumonia features were excluded from the study. Researchers collected clinical and laboratory data, including liver and kidney function, electrolytes, coagulation function, interleukin-6, C-reactive protein, and blood gas analysis. In addition, the researchers collected data on indicators of pulmonary fibrosis including hyaluronic acid, type III procollagen, type IV procollagen, and laminin as determined by the chemiluminescence method.

Patients included in the study were divided into 3 groups: critical (n=11), severe (n=10), and mild (n=11). In the critical group, 3 patients died, and were generally older and had other medical comorbidities. Of the 11 patients admitted to the intensive care unit, 3 received endotracheal intubation and invasive ventilation; 2 patients died after 13 and 20 days of invasive ventilation, respectively.

Of the fibrosis indicators examined, levels of hyaluronic acid, type III procollagen, type IV procollagen, and laminin were all abnormal. The most significant differences of fibrosis indicators across the groups were in the hyaluronic acid and type III procollagen values: critical (667.42±783.78 ng/mL and 23.51±19.26 ng/mL, respectively), severe (86.67±62.71 ng/mL and 10.45±4.77 ng/mL, respectively), and mild (40.33±30.53 ng/mL and 8.53±2.14 ng/mL, respectively) groups. In addition, the overall comparison of the lymphocyte count was significantly different from the first to the seventh examination across all groups (P =.018), which was related to the course of the disease (P =.049).

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Although there were no significant differences in the overall C-reactive protein comparisons (P =.251), there were differences in the first 5 examinations (P <.05), which were related to the course of disease (P =.02). The level of laminin differed only between the critical and mild groups, and there was no statistical difference between the critical and severe groups.

The small sample size was a major limitation of the study, and may have led to biased results. The retrospective nature was another limitation, as was the lack of analysis on the intervention effect of different treatment strategies on these fibrosis indicators. Moreover, although admittedly clinically valuable, the researchers did not analyze the intervention effect of different treatment strategies on fibrosis indicators. Nevertheless, the researchers noted that the fibrosis indicators were advantageous in predicting the severity and prognosis of COVID-19.

“Dynamic observations of lymphocyte count and [C-reactive protein] levels can better reflect the change in patients’ condition, and were closely related to the prognosis,” the researchers wrote. As a result, the researchers recommended that both measurements be taken in patients with COVID-19.


Ding M, Zhang Q, Li Q, Wu T, Huang Y-z. Correlation of the severity and clinical prognosis of 32 cases of patients with COVID-19 [published online April 20, 2020]. Res Med. doi:10.1016/j.rmed.2020.105981