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

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background</jats:bold>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. <jats:bold>Methods</jats:bold>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. (17<jats:sup>th</jats:sup> March 2020 - 1<jats:sup>st</jats:sup> 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.<jats:bold>Results</jats:bold>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<jats:underline>&gt;</jats:underline>70 years (p&lt;0.001), past medical history of cognitive impairment (p<jats:underline>&lt;</jats:underline>0.001), previous delirium (p&lt;0.001), clinical frailty score&gt;3 (p&lt;0.001), hypertension (p&lt;0.05), heart failure (p&lt;0.01), national early warning score (NEWS) &gt;4 (p&lt;0.01), positive CXR (p&lt;0.01), and subsequent positive COVID-19 swab (p<jats:underline>&lt;</jats:underline>0.001) were associated with 30-day mortality. CRP&gt;80 mg/L (p&lt;0.05), albumin &lt;35g/L (p&lt;0.05), peri-operative Glasgow Prognostic Score (poGPS) (p&lt;0.05), lymphocytes &lt;1.5 10<jats:sup>9</jats:sup>/l (p&lt;0.05), neutrophil lymphocyte ratio (p<jats:underline>&lt;</jats:underline>0.001), haematocrit (&lt;0.40 L/L (male) / &lt;0.37 L/L (female)) (p<jats:underline>&lt;</jats:underline>0.01), urea&gt;7.5 mmol/L (p&lt;0.001), creatinine &gt;130 mmol/L (p&lt;0.05) and elevated urea: albumin ratio (&lt;0.001) were also associated with 30-day mortality.On analysis, age <jats:underline>&gt;</jats:underline>70 years (O.R. 3.9, 95% C.I. 1.4 – 8.2, p&lt;0.001), past medical history of heart failure (O.R. 3.3, 95% C.I. 1.2 – 19.3, p&lt;0.05), NEWS &gt;4 (O.R. 2.4, 95% C.I. 1.1 – 4.4, p&lt;0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2-0.9, p&lt;0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1 – 4.4, p&lt;0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n=122), age <jats:underline>&gt;</jats:underline>70 years (O.R. 4.7, 95% C.I. 2.0 - 11.3, p&lt;0.001), past medical history of heart failure (O.R. 4.4, 95% C.I. 1.2 – 20.5, p&lt;0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1- 5.1, p&lt;0.05) remained independently associated with 30-days mortality.<jats:bold>Conclusion</jats:bold>Age <jats:underline>&gt;</jats:underline> 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.</jats:p>

Simple demographic characteristics and laboratory findings on admission may predict in-hospital mortality in patients with SARS-CoV-2 infection: development and validation of the covid-19 score

“…Increased CRP levels and leukocytosis are markers of infection severity and are related to increased mortality [ 29 , 30 ]. Elevated CRP levels are present in numerous mortality risk scores used in patients with SARS-CoV-2 infection, but various studies used different cut-off points [ 8 , 11 , 14 – 16 , 19 ]. In the current study, the cut-off point for CRP levels was at 51.5 mg/dL.…”

Frailty as a Predictor for Mortality Among Patients With COVID-19: A Systematic Review and Meta-Analysis

“…The study design in ve studies was prospective cohort studies [8,12,[18][19][20] , while the others were all retrospective cohort studies [9,11,13,[15][16][17]. There was a variety of countries, ranging from the U.S. to European countries, with 2 in UAS [11,16], four in the UK [8,13,15,20], 1 in Turkey [19],1 in France [17], 1 in Spain [9], 1 in Sweden [12], and 1 in the UK and Italy [18]. Of these, ten study settings were in hospital [8, 9, 11-13, 15, 17-20] and one was in a nursing home [16].…”

“…The largest sample size was in Turkey [19] with 18,234, and the smallest was in France [17] with 94 patients. Among all of the included studies, seven studies used clinical frailty scale as an assessment tool for frailty [8,9,12,13,15,18,20], one for hospital frailty risk score [19], one for frailty index [16], one for palliative performance scale [11] and one for frail non-disabled questionnaire [17]. (shown in…”

“…Frailty was con rmed as a predictor of risk, with worse outcomes such as falls, mortality and lower quality of life in different populations [7]. Several studies have presented the association between frailty and morality in patients with COVID-19, with inconsistent results [8][9][10][11][12][13][14][15][16][17]. Given new articles exploring this association between frailty and mortality [18][19][20], we therefore believe there is an urgent need to summarize the evidence on this important issue.…”

LUCAS: A highly accurate yet simple risk calculator that predicts survival of COVID-19 patients using rapid routine tests

“…Previous medical history, smoking status and current pharmaceutical interventions were not included in the analysis. This rationale was based on consultations with biomedical scientists and clinicians working in A&E departments to determine which rapid and routine laboratory tests would be clinically relevant candidate predictors, as well as previously published literature on prognostic factors associated with SARS CoV-2 infection for the model development [13].…”