Risk Factors for 28-Day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul

Abstract

Objective: In late 2019, the Coronavirus disease 2019 (COVID-19) has been pandemic worldwide, starting in Wuhan, China. In this study, we aimed to evaluate the factors associated with 28-day outcomes in patients admitted to the intensive care unit with the diagnosis of COVID-19. Methods: This study has a retrospective cohort design. COVID-19 patients identified according to World Health Organization guidelines are included. Patient data were recorded to a centralized system utilizing ImdSoft-Meta vision/QlinICU Clinical Decision Support Software. Individual datasets about required parameters were obtained from Structured Query Language (SQL) queries. The main laboratory parameters were examined. SOFA, APACHE II, and Charlson Comorbidity Score (CCS) were calculated. In evaluating laboratory parameters and disease risk scores, which are thought to affect 28-day mortality, logistic analysis were performed using the Backward LR model. Results: The study was carried out with 101 patients, 40 (39.6%) of whom were women, and 61 (60.4%) of men, who met the inclusion criteria. The ages of the patients ranged from 21 to 88, and the mean age was 58.45 ± 15.41 years. The mean intensive care hospitalization period was 12.5 ± 10.2 days. The all-cause in-hospital mortality rate was 61.4%. Leukocyte count, CK, NT-proBNP, PCT, CRP, ferritin, neutrophil count and percentage, D-Dimer, LDH, AST values were found to be significantly higher in non-survivors. The lymphocyte count and percentage, and platelet count values were found to be significantly low in non-survivors. The lymphocyte percentage, LDH, and CCS were significant in the 28-day mortality in multivariate analysis (p values are 0.01, 0.003, 0.008, respectively). Conclusions: High lymphocyte values have been found to significantly reduce the risk of death in patients diagnosed with COVID-19. Lymphocyte percentage, LDH, and CCS were evaluated as the most successful parameters in predicting 28-day mortality in the intensive care unit.

Patient Characteristics and Risk Factors for Mortality in 504 Hospitalized Patients Due to Covid-19

“…Pneumonia, kidney damage, shock status, heart failure, and acute respiratory distress syndrome (ARDS) constitute the main clinical factors affecting COVID-19 mortality. In most patients laboratory parameters associated with COVID-19 mortality were reported as follows: leukocytosis, neutrophilia, elevated levels of alanine aminotransferase (ALT), and aspartate aminotransferase (AST), creatinine, lactate dehydrogenase (LDH), procalcitonin, C-reactive protein (CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), ferritin, D-dimer, lymphopenia, thrombocytopenia, along with decreased levels of albumin (7,8,17,18).…”

What is the impact and efficacy of routine immunological, biochemical and hematological biomarkers as predictors of COVID-19 mortality?

“…Various studies have been conducted on the level of acute phase reactants in COVID-19. In one study, it was reported that ESR, D-dimer, and procalcitonin levels increased significantly in severe cases [1] , [5] . In another study, ferritin and procalcitonin values were found to be high in non-surviving and severe COVID-19 patients.…”

“…In many studies, it has been stated that the levels of serum AST, ALT and LDH, which are liver function tests, were higher in severe COVID-19 patients when compared to the mild COVID-19 patients [1] , [5] , [21] . Onur et al [20] showed that the AST, ALT, and LDH activities were higher in deceased COVID-19 patients than in living patients.…”

“…High values of CRP indicate inflammation caused by various infections [16] . In many studies examining the changes in routine laboratory parameters in COVID-19, increased CRP levels were reported in severe patients when compared to mild patients [1] , [5] , [20] . In another study, it was stated that COVID patients who died had higher CRP levels than living infected patients [2] .…”

“…While the number of cases is increasing day by day, there is limited information about the hematological and laboratory findings of the disease [ [2] , [3] , [39] ]. It was reported that routine laboratory data showed significant changes in COVID-19, but could not be fully elucidated, especially in patients who died [ [4] , [5] , [38] ].…”