Laboratory abnormalities and risk factors associated with in‐hospital death in patients with severe COVID‐19

Abstract

Background In the context of the COVID‐19 outbreak of worldwide, we aim to analyze the laboratory risk factors of in‐hospital death in patients with severe COVID‐19. Methods All ≥18‐year‐old patients with confirmed severe COVID‐19 admitted to Tongji Hospital (Wuhan, China) from February 3 to February 20, 2020, were retrospectively enrolled and followed up until March 20, 2020. Epidemiological, clinical, laboratory, and treatment data were collected and explored the risk factors associated with in‐hospital death. Results A total of 73 severe patients were enrolled in the study, of whom 20 (27%) patients died in hospital during the average 28 days of follow‐up period. The median age of non‐survivors was significantly older than survivors (69 [64‐76.5] years vs 64 [56‐71.3] years, P = .033) and 15 (75%) patients were males. The laboratory abnormalities of non‐survivors mainly presented in serious inflammation response and multiple organ failure, with high levels of cytokines and deranged coagulation parameters. Multivariable regression showed that neutrophil count greater than 4.47 × 109/L (OR, 58.35; 95%CI: 2.16‐1571.69; P = .016), hypersensitivity C‐reactive protein greater than 86.7 mg/L (OR, 14.90; 95%CI: 1.29‐171.10; P = .030), creatine kinase greater than 101 U/L (OR, 161.62; 95%CI: 6.45‐4045.20; P = .002), and blood urea nitrogen greater than 6.7 mmol/L (OR, 11.18; 95%CI: 1.36‐91.62; P = .024) were risk factors for in‐hospital death. Conclusion The risk factors of neutrophil count, hypersensitivity C‐reactive protein, creatine kinase, and blood urea nitrogen could help clinicians to early identify COVID‐19 severe patients with poor outcomes on admission. Virus direct attack and cytokine storm play a major role in the death of COVID‐19.

Correlations of disease severity and age with hematology parameter variations in patients with COVID‐19 pre‐ and post‐treatment

“…Further analysis revealed that CD3+, CD8+, total lymphocytes, platelets, and basophils in patients older than 50 were significantly lower than in patients younger than 50 ( P = P = .049, .018, .019, .010, and .039, respectively), while neutrophils, NLR, CRP level, and RBC RDW in patients older than 50 were significantly higher than in patients younger than 50 ( P = .0191, .015, .009, and .010, respectively) (Table 4). These results were similar to previous reports 14,28,29,38‐41 . The reduction of T‐cell subsets and the high CD4+/CD8+ T‐cell ratio are associated with disease severity; older‐aged cases tend to be more severe; thus, more lymphocytes would be consumed or severely impaired in the immune reaction.…”

Nervous system diseases are associated with the severity and mortality of patients with COVID-19: a systematic review and meta-analysis

“…The sample size per study ranged from 27 to 1590 (total 17 879; 9686 males). Considering methodological quality in items of NOS scale, 23 studies [ 4 , 17 , 19 , 21 , 24 , 27 – 29 , 33 , 34 , 37 , 46 , 49 , 55 , 58 , 61 , 65 , 67 – 69 , 73 , 75 , 76 ] were rated as high quality (>7 stars) and 46 studies [ 18 , 20 , 22 , 23 , 25 , 26 , 30 – 32 , 35 , 36 , 38 – 45 , 47 , 48 , 50 – 54 , 56 , 57 , 59 , 60 , 62 – 64 , 66 , 70 – 72 , 74 , 77 – 84 ] were rated as moderate quality (5−7 stars). The detailed characteristics and quality of the included studies are summarised in Table 1 .…”

“…Twenty-four studies [ 18 – 21 , 23 , 24 , 27 , 28 , 31 , 32 , 34 , 36 , 40 , 42 , 52 , 61 – 63 , 72 , 74 , 76 , 77 , 81 , 82 ], including 6822 patients, reported cerebrovascular disease data between non-survivors and survivors. The meta-analysis demonstrated that cerebrovascular disease was associated with death in COVID-19 patients (OR = 3.45, 95% CI: 2.46 to 4.84, P < 0.001; I 2 = 35.2%) ( Fig.…”

“…No significant differences were found in the prevalence of stroke (4 studies [ 21 , 40 , 72 , 77 ], 936 patients; OR = 1.79, 95%CI: 0.76 to 4.23, P = 0.185; I 2 = 13.0%) and epilepsy (2 studies [ 28 , 40 ], 167 patients; OR = 2.08, 95%CI: 0.08 to 50.91, P = 0.654; I 2 = 92.0%) between non-survival and survival patients ( Fig. 7 ).…”

Differential diagnosis of coronavirus disease 2019 pneumonia or influenza A pneumonia by clinical characteristics and laboratory findings

“…Moreover, albumin is an independent risk factor for differentiating COVID‐19 pneumonia from influenza A pneumonia. In addition, Chen et al 21 reported that neutrophil count, hypersensitivity C‐reactive protein, creatine kinase, and blood urea nitrogen are the risk factors of COVID‐19 severe patients with poor outcomes on admission.…”