Admission Predictors of Mortality in Hospitalized COVID-19 Patients—A Serbian Cohort Study

Abstract

Background: Early prediction of COVID-19 patients’ mortality risk may be beneficial in adequate triage and risk assessment. Therefore, we aimed to single out the independent morality predictors of hospitalized COVID-19 patients among parameters available on hospital admission. Methods: An observational, retrospective–prospective cohort study was conducted on 703 consecutive COVID-19 patients hospitalized in the University Clinical Center Kragujevac between September and December 2021. Patients were followed during the hospitalization, and in-hospital mortality was observed as a primary end-point. Within 24 h of admission, patients were sampled for blood gas and laboratory analysis, including complete blood cell count, inflammation biomarkers and other biochemistry, coagulation parameters, and cardiac biomarkers. Socio-demographic and medical history data were obtained using patients’ medical records. Results: The overall prevalence of mortality was 28.4% (n = 199). After performing multiple regression analysis on 20 parameters, according to the initial univariate analysis, only four independent variables gave statistically significant contributions to the model: SaO2 < 88.5 % (aOR 3.075), IL-6 > 74.6 pg/mL (aOR 2.389), LDH > 804.5 U/L (aOR 2.069) and age > 69.5 years (aOR 1.786). The C-index of the predicted probability calculated using this multivariate logistic model was 0.740 (p < 0.001). Conclusions: Parameters available on hospital admission can be beneficial in predicting COVID-19 mortality.

Importance of Demographic and Clinical Features in Evaluating the Severity of COVID-19 in Hospitalized Patients: A Serbian Retrospective Study in the First Pandemic Year

“…Laboratory markers associated with increased risk for severe disease include lymphocytopenia, neutrophilia, and elevated serum ALT, AST, LDH, CRP, and ferritin [23,24]. Furthermore, our results agree with the majority of authors [5,7,21,25] in that lymphopenia and elevated values of AST and LDH were statistically significantly more frequent in patients with severe forms of the disease. We can assume that a reduced number of lymphocytes is a consequence of viral attachment, damage to the immune system, or exudation of circulating lymphocytes into the inflammatory lung tissue.…”

Inflammation as Prognostic Hallmark of Clinical Outcome in Patients with SARS-CoV-2 Infection

“…When compared to moderate illness, PCT is four times higher in severe patients and eight times higher in critical patients, according to Hu R. et al [ 11 ]. Likewise, several authors found that PCT levels are increased in patients with a fatal outcome of severe COVID-19 both at admission and during the course of hospitalization [ 10 , 12 , 13 ]. In addition, Sayah W. et al assessed that PCT and the neutrophil-to-lymphocyte ratio are not influenced by the administration of CTS.…”

“…Consistently, other studies reported that patients older than 65 suffering from comorbidities experienced more severe symptoms, MODS and death [ 27 , 58 ]. Hypertension and obesity are the most frequent comorbidities in patients with severe or fatal COVID-19, and the main cause of death after ARDS is a cardiovascular acute event, such as myocardial dysfunction, arrhythmia or shock [ 10 , 12 , 13 , 26 , 59 , 60 ]. Instead, according to other authors, COVID-19-deceased patients presented, at admission, more frequently with chronic kidney disease and neurological diseases [ 13 ].…”

“…Hypertension and obesity are the most frequent comorbidities in patients with severe or fatal COVID-19, and the main cause of death after ARDS is a cardiovascular acute event, such as myocardial dysfunction, arrhythmia or shock [ 10 , 12 , 13 , 26 , 59 , 60 ]. Instead, according to other authors, COVID-19-deceased patients presented, at admission, more frequently with chronic kidney disease and neurological diseases [ 13 ]. Obesity, diabetes and chronic kidney disease are also independent risk factors for intubation, as well as death [ 61 ].…”

The laboratory parameters in predicting the severity and death of COVID-19 patients: Future pandemic readiness strategies

“…The most common laboratory abnormalities seen in hospitalized COVID-19 patients include lymphocytopenia accompanied by an elevated neutrophil count, thrombocytopenia, anemia, raised LDH levels, D-dimer, CRP, liver enzymes, and decreased albumin levels [ 67–69 ]. Specific markers, such as lymphocytopenia, neutropenia, elevated serum liver enzymes, LDH, CRP, and ferritin, have been associated with an elevated risk of severe disease [ 66 , 70 , 71 ]. Elevated levels of CRP and reduced albumin levels are crucial indicators of severe disease progression [ 72 , 73 ], indicating the development of cytokine storm in COVID-19 patients.…”