Predictors of Mortality in Patients with Severe COVID-19 Pneumonia—A Retrospective Study

Abstract

Introduction: The novel coronavirus pandemic has caused significant mortality throughout the world. This study was done as there is scarce data on mortality predictors in severe COVID-19 pneumonia patients admitted to ICU in the Indian population. Material and methods: A retrospective study was conducted on COVID-19 pneumonia patients admitted to tertiary care center during June–October 2020. The records of patients admitted to ICU were collected and data included demography, symptoms, comorbidites and vital parameters. Laboratory parameters included complete hemogram, random blood sugar, S.Ferritin, S.LDH, renal function test, liver function test. Treatment-associated information such as the use of remdesivir, timing of initiating rem-desivir after the symptom onset, the use of steroids, use of anticoagulants, use of HFNC, NIV, ventilator were collected. 30 days mortality data post-discharge was collected via telephonic interview. Results: 4,012 confirmed cases of COVID-19 were admitted to hospital, of which 560 (13.95%) with severe pneumonia were included in the study. Mean age was 57.75 ± 13.96 years. The mortality rates were 54.64% among severe COVID-19 cases and 5% among mild to moderate COVID-19 cases. The Cox multinominal regression analysis identified SpO2/FiO2 < 400, age > 50 years, duration of symptom > 4 days, serum ferritin > 450 µg/L, respiratory rate > 23/min, the presence of comorbidities and non-usage of remdesivir were independently associated with increased mortality. Mortality rate at 30 days was 56.60%. Conclusion: Severe COVID-19 pneumonia is associated with very high mortality, especially in a resource-constrained setting. The use of remdesivir may have to be considered early in the course of disease to prevent excess mortality related to COVID-19.

Visceral fat inflammation and fat embolism are associated with lung’s lipidic hyaline membranes in subjects with COVID-19

“…Since December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the development of coronavirus disease 2019 (COVID-19), has spread globally, resulting in a worldwide health crisis that caused over five million deaths [ 1 ]. The lung is a crucial target organ not only due to the severe bilateral pneumonia observed in 15–30% of hospitalized patients [ 2 , 3 ] but also because it is the site from which the infection spreads to blood vessels, heart, gut, brain, and kidneys [ 4 ]. Published data support interstitial fibrosis with alveolar hyaline membrane (HM) formation as the main underlying histopathologic event responsible for pneumonia and acute respiratory syndrome distress [ 5 , 6 ].…”

Evaluation of Antibacterial and Antiviral Drug Effectiveness in COVID-19 Therapy: A Data-Driven Retrospective Approach

“…In general, the mortality risk of COVID-19 patients with comorbidities had been reported to be higher than patients without comorbidities [ 3 , 53 , 54 , 55 ]. A study of severe COVID-19 pneumonia showed that of 55% deceased patients, 70% of them had reported having comorbidities (e.g., hypertension, diabetes, ischemic heart disease) [ 56 ]. Another cohort retrospective study of hospitalized COVID-19 patients had reported that 32% of deceased patients had pneumonia [ 57 ].…”

“…Another cohort retrospective study of hospitalized COVID-19 patients had reported that 32% of deceased patients had pneumonia [ 57 ]. Although relatively high, this number was lower than patients with severe COVID-19 pneumonia [ 56 ]. Their results were similar to our study where COVID-19 pneumonia was a stronger predictor of COVID-19 recovery compared to existing respiratory comorbidity.…”

Dying “from” or “with” COVID-19 during the Pandemic: Medico-Legal Issues According to a Population Perspective

“…Advanced age, as for many other diseases and infections, is a known risk factor for COVID-19 and its complications; it has been observed that the majority of patients affected by severe COVID-19 pneumonia are elderly and that, of all the predictors of mortality in COVID-19 pneumonia, advanced age is the most important [32,33]. This correlation can be explained by the physiological deterioration of one's immune system that occurs with age, as well as by the age-dependent loss of T cells and T cell subtypes [34,35]. Lymphopenia, increased CRP, and erythrocyte sedimentation were observed in the laboratory results of COVID-19 patients [36].…”