COVID-19: Risk Factors Identified for Poor Prognosis, In-Hospital Mortality

The pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, has led to numerous cases and deaths around the world and global action has been initiated to contain the virus and prevent further transmission.

Older age, high Sequential Organ Failure Assessment (SOFA) score, and blood d-dimer levels >1 μg/mL on admission are significant early stage risk factors for poor prognosis and in-hospital mortality in patients with COVID-19, according to study findings published in The Lancet.

Researchers from China performed a retrospective cohort review of adult patients with laboratory-confirmed COVID-19 (median age, 56 years; interquartile range [IQR], 46-67) who were admitted to the Jinyintan Hospital (n=135) and Wuhan Pulmonary Hospital (n=56), China. Only patients who had been discharged from the hospital or had died from December 2019 and to January 31, 2020 were included.

Electronic medical records were used to obtain patients’ demographic, clinical, treatment, and laboratory data. These data were compared between people who survived and continued to be discharged and people who did not survive. The investigators explored significant risk factors associated with in-hospital mortality in individuals who died relative to survivors using univariable and multivariable logistic regression models.

A total of 137 patients were discharged home after admission vs 54 patients who died in the hospital. The median time from pre-admission illness onset to hospital discharge was 22 days (interquartile range [IQR], 18-25 days), and the median time to in-hospital death was 18.5 days (IQR, 15-22 days).

Approximately 48% (n=91) patients in the overall cohort had a comorbidity. The most common comorbidities in this patient population were hypertension (30%), diabetes (19%), and coronary heart disease (8%).

According to data from electronic health records and findings from the multivariable regression, risk factors significantly associated with increasing odds of in-hospital mortality in patients with COVID-19 included older age (odds ratio [OR], 1.10; 95% CI, 1.03-1.17, per year increase; P =.0043), higher SOFA score (OR, 5.65; 2.61-12.23; P <.0001), and d-dimer levels >1 μg/mL (OR, 18.42; 95% CI, 2.64-128.55; P =.0033) at time of admission.

In survivors, the median duration of viral shedding was 20 days (IQR, 17-24 days), with the shortest and longest durations being 8 and 37 days, respectively. The researchers found that SARS-CoV-2 was consistently detectable until death in patients who did not survive.

Study limitations included its retrospective design, inconsistencies in standardization of lab tests performed, the inclusion of some patients who were transferred late in their disease, as well as the exclusion of patients who are still receiving hospital care, which may have led to under- or overestimation of the true COVID-19 mortality rate.

According to the investigators, the prolonged viral shedding observed in this retrospective cohort “provides the rationale for testing novel coronavirus antiviral interventions in efforts to improve outcomes.”

Reference

Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published online March 11, 2020]. Lancet. doi:10.1016/S0140-6736(20)30566-3