Predictors for in-hospital mortality from coronavirus disease 2019 (COVID-19) infection among adults aged 18–65 years

Bhargava, Ashish; Sharma, Mamta; Akagi, Elisa; Szpunar, Susanna; Saravolatz, Louis D.

doi:10.1017/ice.2020.1390

Cited by 10 publications

(10 citation statements)

References 9 publications

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“…15 We previously showed that bedside qSOFA score at the time of hospitalization can predict in-hospital mortality among adults aged ≤65 years with COVID-19, for patients with qSOFA scores of 0, 1, 2, and 3 at the time of hospital admission, the mortality rates were 8.7%, 19.7%, 41.7%, and 60%, respectively. 16 In our present study, men and women both demonstrated a linear trend of increase in mortality with increasing qSOFA score (P < .001). From multivariable analysis, every 1-unit increase in qSOFA score increased the risk of death by 80% in men and 90% in women.…”

Section: Discussionsupporting

confidence: 57%

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Do risk factors at the time of hospital admission differ by sex for in-hospital mortality from coronavirus disease 2019 (COVID-19)?

Sharma

Bhargava

Szpunar

et al. 2021

ASHE

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Background: Sex-disaggregated data for coronavirus disease 2019 (COVID-19) reported higher hospitalized fatality rates among men than women. Objective: To determine whether the risk factors for in-hospital mortality from COVID-19, present at the time of hospital admission, differed by patient sex. Design and setting: Single-center, retrospective cohort study at a tertiary-care urban academic center. Methods: We reviewed the electronic medical records of patients positive for COVID-19 via qualitative polymerase chain reaction (PCR) assay, admitted between March 8 and June 14, 2020. Patients were stratified by sex to assess the association of variables present on admission with in-hospital mortality. Results: The overall inpatient case fatality rate (CFR) was 30.4% (172 of 565). The CFR among male patients was higher than among female patients: 99 (33.7%) versus 73 (26.9%), respectively (P = .08). Among males, comorbid conditions associated with in-hospital mortality were chronic pulmonary disease (P = .02) and connective tissue disease (P = .03). Among females, these comorbid conditions were congestive heart failure (P = .03), diabetes with complication (P = .05), and hemiplegia (P = .02). Variables that remained independently associated with death in males included age >70 years, public insurance, incremental increase in quick sepsis-related organ failure assessment (qSOFA) and C-reactive protein (CRP), lymphocytopenia, and thrombocytopenia. Among females, variables that remained independently associated with mortality included public insurance, incremental increase in Charlson weighted index of comorbidity (CWIC) score, qSOFA, and CRP. Conclusions: Risk factors for in-hospital mortality by sex included public insurance type, incremental increase in qSOFA and CRP in both sexes. For male patients, older age, lymphocytopenia and thrombocytopenia were also associated with mortality, whereas a higher Charlson score was associated with in-hospital mortality in female patients.

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Section: Discussionsupporting

confidence: 57%

“…In an earlier study among adults aged ≤65 years with COVID-19, 37.5% of nonsurvivors had thrombocytopenia on presentation, compared to 14% of survivors. 16 In our study, thrombocytopenia was associated with mortality in men only.…”

Section: Discussionsupporting

confidence: 42%

Do risk factors at the time of hospital admission differ by sex for in-hospital mortality from coronavirus disease 2019 (COVID-19)?

Sharma

Bhargava

Szpunar

et al. 2021

ASHE

Self Cite

View full text Add to dashboard Cite

show abstract

“…29 We previously showed that bedside qSOFA score at the time of hospitalization can predict in-hospital mortality among adults 65 years with COVID-19 after adjusting for CWIC score and thrombocytopenia. 30 In that study, for patients with qSOFA score of 0, 1, 2 and 3 at the time of hospital admission, the mortality rates were 8.7%, 19.7%, 41.7% and 60%, respectively. 30 An early study from China noted higher SOFA scores on admission were associated with a higher odds of in-hospital death.…”

Section: Discussionmentioning

confidence: 83%

“…30 In that study, for patients with qSOFA score of 0, 1, 2 and 3 at the time of hospital admission, the mortality rates were 8.7%, 19.7%, 41.7% and 60%, respectively. 30 An early study from China noted higher SOFA scores on admission were associated with a higher odds of in-hospital death. 20 There is limited information on qSOFA as a predictor of mortality.…”

Section: Discussionmentioning

confidence: 83%

Clinical Features and Risk Factors for In-Hospital Mortality From COVID-19 Infection at a Tertiary Care Medical Center, at the Onset of the US COVID-19 Pandemic

Bhargava

Szpunar

Sharma

et al. 2021

J Intensive Care Med

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Background: Mortality from COVID-19 has been associated with older age, black race, and comorbidities including obesity, Understanding the clinical risk factors and laboratory biomarkers associated with severe and fatal COVID-19 will allow early interventions to help mitigate adverse outcomes. Our study identified risk factors for in-hospital mortality among patients with COVID-19 infection at a tertiary care center, in Detroit, Michigan. Methods: We conducted a single-center, retrospective cohort study at a 776-bed tertiary care urban academic medical center. Adult inpatients with confirmed COVID-19 (nasopharyngeal swab testing positive by real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay) from March 8, 2020, to June 14, 2020, were included. Clinical information including the presence of comorbid conditions (according to the Charlson Weighted Index of Comorbidity (CWIC)), initial vital signs, admission laboratory markers and management data were collected. The primary outcome was in-hospital mortality. Results: Among 565 hospitalized patients, 172 patients died for a case fatality rate of 30.4%. The mean (SD) age of the cohort was 64.4 (16.2) years, and 294 (52.0%) were male. The patients who died were significantly older (mean [SD] age, 70.4 [14.1] years vs 61.7 [16.1] years; P < 0.0001), more likely to have congestive heart failure (35 [20.3%] vs 47 [12.0%]; P = 0.009), dementia (47 [27.3%] vs 48 [12.2%]; P < 0.0001), hemiplegia (18 [10.5%] vs 18 [4.8%]; P = 0.01) and a diagnosis of malignancy (16 [9.3%] vs 18 [4.6%]; P = 0.03).From multivariable analysis, factors associated with an increased odds of death were age greater than 60 years (OR = 2.2, P = 0.003), CWIC score (OR = 1.1, P = 0.023), qSOFA (OR = 1.7, P < 0.0001), WBC counts (OR = 1.1 , P = 0.002), lymphocytopenia (OR = 2.0, P = 0.003), thrombocytopenia (OR = 1.9, P = 0.019), albumin (OR = 0.6 , P = 0.014), and AST levels (OR = 2.0, P = 0.004) on admission. Conclusions: This study identified risk factor for in-hospital mortality among patients admitted with COVID-19 in a tertiary care hospital at the onset of U.S. Covid-19 pandemic. After adjusting for age, CWIC score, and laboratory data, qSOFA remained an independent predictor of mortality. Knowing these risk factors may help identify patients who would benefit from close observations and early interventions.

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“…Recent reports from several countries have suggested that older age, male gender, history of heart disease [ 3 , 4 ], and baseline chronic conditions [ 5 ] are significantly associated with poor outcomes. Hypertension (HTN) is associated with poor outcomes, and anticoagulant treatment may be associated with clinical benefits in terms of survival in patients with COVID-19 [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospital

Barry¹,

Alotaibi²,

Almohaya³

et al. 2021

Journal of Infection and Public Health

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Background Coronavirus disease 2019 (COVID-19) has resulted in millions of deaths, including more than 6000 deaths in the Kingdom of Saudi Arabia (KSA). Identifying key predictors of intensive care unit (ICU) admission and mortality among infected cases would help in identifying individuals at risk to optimize their care. We aimed to determine factors of poor outcomes in hospitalized patients with COVID-19 in a large academic hospital in Riyadh, KSA that serves as a Middle East Respiratory Syndrome coronavirus (MERS-CoV) referral center. Methods This is a single-center retrospective cohort study of hospitalized patients between March 15 and August 31, 2020. The study was conducted at King Saud University Medical City (KSUMC). COVID-19 infection was confirmed using real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-COV-2. Demographic data, clinical characteristics, laboratory, radiological features, and length of hospital stay were obtained. Poor outcomes were, admission to ICU, need for invasive mechanical ventilation (IMV), and in-hospital all-cause mortality. Results Out of 16,947 individuals tested in KSUMC, 3,480 (20.5%) tested positive for SARS-CoV-2 and of those 743 patients (21%) were hospitalized. There were 62% males, 77% were younger than 65 years. Of all cases, 204 patients (28%) required ICU admission, 104 (14%) required IMV, and 117 (16%) died in hospital. In bivariate analysis, multiple factors were associated with mortality among COVID-19 patients. Further multivariate analysis revealed the following factors were associated with mortality: respiratory rate more than 24/min and systolic blood pressure < 90 mmHg in the first 24 hours of presentation, lymphocyte count <1 × 10 9 /L and aspartate transaminase level > 37 units/L in the first 48 hours of presentation, while a RT-PCR cycle threshold (Ct) value ≤24 was a predictor for IMV. Conclusion Variable factors were identified as predictors of different outcomes among COVID-19 patients. The only predictor of IMV was a low initial Ct values of SARS-CoV-2 PCR. The presence of tachypnea, hypotension, lymphopenia, and elevated AST in the first 48 hours of presentation were independently associated with mortality. This study provides possible independent predictors of mortality and invasive mechanical ventilation. The data may be helpful in the early identification of high-risk COVID-19 patients in areas endemic with MERS-CoV.

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Predictors for in-hospital mortality from coronavirus disease 2019 (COVID-19) infection among adults aged 18–65 years

Cited by 10 publications

References 9 publications

Do risk factors at the time of hospital admission differ by sex for in-hospital mortality from coronavirus disease 2019 (COVID-19)?

Do risk factors at the time of hospital admission differ by sex for in-hospital mortality from coronavirus disease 2019 (COVID-19)?

Clinical Features and Risk Factors for In-Hospital Mortality From COVID-19 Infection at a Tertiary Care Medical Center, at the Onset of the US COVID-19 Pandemic

Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospital

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