Prognostic factors in patients admitted to an urban teaching hospital with COVID-19 infection

Abstract

Background Severe COVID-19 infection results in a systemic inflammatory response (SIRS). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure. Methods Electronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020—1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age, sex, BMI and documented evidence of COVID-19 infection at time of discharge or death certification were considered minimal criteria for inclusion. Results Of the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure (75%) and multiorgan failure (12%) were the commonest causes of death recorded. Age ≥ 70 years (p < 0.001), past medical history of cognitive impairment (p ≤ 0.001), previous delirium (p < 0.001), clinical frailty score > 3 (p < 0.001), hypertension (p < 0.05), heart failure (p < 0.01), national early warning score (NEWS) > 4 (p < 0.01), positive CXR (p < 0.01), and subsequent positive COVID-19 swab (p ≤ 0.001) were associated with 30-day mortality. CRP > 80 mg/L (p < 0.05), albumin < 35 g/L (p < 0.05), peri-operative Glasgow Prognostic Score (poGPS) (p < 0.05), lymphocytes < 1.5 109/l (p < 0.05), neutrophil lymphocyte ratio (p ≤ 0.001), haematocrit (< 0.40 L/L (male)/ < 0.37 L/L (female)) (p ≤ 0.01), urea > 7.5 mmol/L (p < 0.001), creatinine > 130 mmol/L (p < 0.05) and elevated urea: albumin ratio (< 0.001) were also associated with 30-day mortality. On multivariate analysis, age ≥ 70 years (O.R. 3.9, 95% C.I. 1.4–8.2, p < 0.001), past medical history of heart failure (O.R. 3.3, 95% C.I. 1.2–19.3, p < 0.05), NEWS > 4 (O.R. 2.4, 95% C.I. 1.1–4.4, p < 0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2–0.9, p < 0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1–4.4, p < 0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n = 122), age ≥ 70 years (O.R. 4.7, 95% C.I. 2.0—11.3, p < 0.001), past medical history of heart failure (O.R. 4.4, 95% C.I. 1.2–20.5, p < 0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1–5.1, p < 0.05) remained independently associated with 30-days mortality. Conclusion Age ≥ 70 years and severe systemic inflammation as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection.

Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis

“…We found 391 relevant articles from three databases, PubMed (183), Embase (195), and Cochrane Library (13). After using Endnote software to delete duplications, 296 articles remained.…”

“…The study design in seven studies was prospective cohort studies [8,12,[17][18][19][20]22], while the others were all retrospective cohort studies [11,13,15,16,21,[23][24][25]. There were a variety of countries, ranging from the U.S. to European countries, with 2 in the USA [11,24], five in the UK [8,13,15,19,22], 1 in Turkey [18],1 in France [16], 1 in Switzerland [23], 2 in Spain [21,25], 2 in Sweden [12,20], and 1 in the UK and Italy [17]. Of these, 13 study settings were in the hospital [8, 11-13, 15-20, 22, 23, 25] and two were in a nursing home [21,24].…”

“…The largest sample size was in Turkey [18], with 18,234 patients, and the smallest was in France [16], with 94 patients. Among all of the included studies, 11 studies used the clinical frailty scale (CFS) as an assessment tool for frailty [8,12,13,15,17,[19][20][21][22][23]25], one used the hospital frailty risk score [18], one used the frailty index [24], one used the palliative performance scale [11] and one used the frail nondisabled questionnaire [16]. Detailed information of adjustment variables for each study was shown in Supplemental Table 1.…”

The systemic inflammatory response and clinicopathological characteristics in patients admitted to hospital with COVID-19 infection: Comparison of 2 consecutive cohorts

“…These whole-body changes are characteristic of a systemic inflammatory response to tissue injury. Indeed, measures of this systemic inflammatory response have been shown to have prognostic value (4)(5)(6). In particular, the 4C mortality score was developed in more than 55,000 patients with COVID-19 and measured the systemic inflammatory response using C-reactive protein (6).…”

“…Calculation of the Neutrophil Lymphocyte Ratio (NLR) Peri-operative Glasgow Prognostic Score (poGPS) Demographical and clinicopathological data were presented as categorical variables using recognised clinical thresholds. These variables were analysed using χ Details of the recruitment of patients for cohort (n=243) have been previously described(5). In cohort 2, of the 356 patients who were confirmed to have COVID-19 infection by PCR test, 278 patients fulfilled the criteria for inclusion with age, sex, BMI.…”