Characteristics of patients with COVID-19 who have deteriorating chest X-ray findings within 48 hours: a retrospective cohort study

Abstract Background The severity of chest X-ray (CXR) findings is a prognostic factor in patients with coronavirus disease 2019 (COVID-19). However, the prognostic impact of deterioration of CXR findings and the clinical characteristics of patients with worsening CXR findings remain unclear. We aimed to investigate the clinical and genetic characteristics, as well as the prognosis, of patients with worsening CXR findings during early hospitalisation. Methods We retrospectively included 1656 consecutive Japanese patients with COVID-19 recruited through the Japan COVID-19 Task Force. Rapid deterioration of CXR findings was defined as increased pulmonary infiltrates in ≥ 50% of the lung fields within 48 h of admission. Results Rapid deterioration of CXR findings was an independent risk factor for death, most severe illness, tracheal intubation, and intensive care unit admission. The presence of consolidation on CXR, comorbid cardiovascular and chronic obstructive pulmonary diseases; high body temperature (≥ 37.7°C); and increased levels of serum aspartate aminotransferase (≥ 30 IU/L), potassium (≥ 4.3 mEq/L), and C-reactive protein (≥ 2.53 mg/dL) were independent risk factors for rapid deterioration of CXR findings. The risk variant at the ABO locus (rs529565-C) was associated with rapid deterioration of CXR findings in all patients with COVID-19. Further, the population-specific risk variant at the DOCK2 locus (rs60200309-A) was nominally associated with rapid deterioration of CXR findings in patients aged < 65 years. Conclusions This study revealed the clinical features, genetic features, and risk factors for rapid deterioration of CXR findings in patients with COVID-19. Rapid deterioration of CXR findings is a poor prognostic factor for patients with COVID-19.