Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study

Abstract

Rationale: Up to date, the exploration of clinical features in severe COVID-19 patients were mostly from the same center in Wuhan, China. The clinical data in other centers is limited. This study aims to explore the feasible parameters which could be used in clinical practice to predict the prognosis in hospitalized patients with severe coronavirus disease-19 . Methods: In this case-control study, patients with severe COVID-19 in this newly established isolation center on admission between 27 January 2020 to 19 March 2020 were divided to discharge group and death event group. Clinical information was collected and analyzed for the following objectives: 1. Comparisons of basic characteristics between two groups; 2. Risk factors for death on admission using logistic regression; 3. Dynamic changes of radiographic and laboratory parameters between two groups in the course. Results: 124 patients with severe COVID-19 on admission were included and divided into discharge group (n=35) and death event group (n=89). Sex, SpO2, breath rate, diastolic pressure, neutrophil, lymphocyte, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), and D-dimer were significantly correlated with death events identified using bivariate logistic regression. Further multivariate logistic regression demonstrated a significant model fitting with C-index of 0.845 (p<0.001), in which SpO2≤89%, lymphocyte≤0.64×10 9 /L, CRP>77.35mg/L, PCT>0.20μg/L, and LDH>481U/L were the independent risk factors with the ORs of 2. 959, 4.015, 2.852, 3.554, and 3.185, respectively (p<0.04). In the course, persistently lower lymphocyte with higher levels of CRP, PCT, IL-6, neutrophil, LDH, D-dimer, cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and increased CD4+/CD8+ T-lymphocyte ratio and were observed in death events group, while these parameters stayed stable or improved in discharge group. Conclusions: On admission, the levels of SpO2, lymphocyte, CRP, PCT, and LDH could predict the prognosis of severe COVID-19 patients. Systematic inflammation with induced cardiac dysfunction was likely a primary reason for death events in severe COVID-19 except for acute respiratory distress syndrome.

Radiology Departments as COVID-19 entry-door might improve healthcare efficacy and efficiency, and Emergency Department safety

“…Furthermore, the characteristics of age, gender and oximetry of our G2 patients were similar to those previously reported [9,18], and the way both cohorts were nally built up within a strict home-con nement regional strategy reproduces a real setting whose results might be used as a model in ongoing pandemic waves. Furthermore, we believe that the higher pcHRRS discriminative performance makes bene cial to maintain and expand the RD entry-door role in the long term to be prepared for future COVID-19 waves or other similar pandemics.…”

The impact of vital signs on the death of patients with new coronavirus pneumonia: A systematic review and meta-analysis

“…Accelerated heart rate indicates the damage of myocardial energy supply, and one of the complications of patients with COVID-19 is acute myocardial injury. Study has shown that in addition to acute respiratory distress syndrome (ARDS), systemic inflammation with cardiac dysfunction is the main cause of death from severe COVID-19 [23] . So early detection of changes in heart rate and prevention of complications can decrease the mortality of the disease.…”

“…Thereafter, 119 articles were excluded by the titles and abstracts, and 43 of the remaining 56 articles were deleted for various reasons, and we were left with 13 articles. According to the literature quality evaluation, 12 articles of 3493 patients [16][17][18][19][20][21][22][23][24][25][26][27][28] were ultimately selected for the meta-analysis ( Figure 1). All these selected studies were published in 2020 with varying sample sizes ranging from 20 to 7614 patients.…”

Association of Peripheral Lymphocyte and the Subset Levels With the Progression and Mortality of COVID-19: A Systematic Review and Meta-Analysis

“…The search strategy identified 7,385 records: 6,528 from PubMed, 465 from CNKI, 322 from Wangfan, and 70 from other sources (Figure 1). After excluding duplicated and irrelevant records, 16 studies were included in this meta-analysis with a total of 10,624 COVID-19 cases ( Table 1) (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Thirteen studies derived from China, while one study came from the USA, one from Spain and one from India.…”