Risk factors of COVID-19 clinical worsening: A retrospective cohort study in COVID-19 referral hospital in west Java, Indonesia

Background: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is marked as one of the highly pathogenic viruses, resulting in millions of deaths worldwide. Management of COVID-19 in limited resources requires appropriate decisions. Clinical considerations along with simple laboratory parameters that can predict the worsening are needed to determine which patients should be treated more intensively. Methods: This is a retrospective cohort study based on the Research Electronic Data Capture (REDCap) registry of COVID-19 patients in Hasan Sadikin General Hospital from April to December 2020. Patients were divided into worsening and non-worsening groups within a 14-day follow-up. Factors affecting these conditions were analyzed. Results: A total of 537 patients were included in this study, of which 72 patients suffered deterioration. Multivariate analysis showed the significant factors affecting the worsening of COVID-19 patients were age > 60 years (aOR 4.207, 95% CI 2.13-8.32), heart disease (aOR 2.802, 95% CI 1.12-6.99), diabetes mellitus (aOR 3.107, 95% CI 1.43-6.74), respiratory rate > 23x/minute (aOR 3.71, 95% CI 1.87-7.38), and NLR > 3.8 (aOR 2.51, 95% CI 1.21-5.21). Conclusions: Older age, chronic heart disease, diabetes mellitus, tachypnea, and higher neutrophil-to-lymphocyte ratio (NLR) are risk factors for the clinical worsening of COVID-19 and can be useful to predict the worsening outcome and poor prognosis.