Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities

Liu, Weifang; Yang, Chengzhang; Liao, Yuangao; Wan, Feng; Lin, Lijin; Huang, Xuewei; Zhang, Binghong; Yua, Yuan; Zhang, Peng; Zhang, Xiaojing; She, Zhi‐Gang; Wang, Lei; Li, Hongliang

doi:10.1016/j.jiph.2021.11.012

Cited by 40 publications

(44 citation statements)

References 44 publications

(56 reference statements)

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“…It was found that the risk factor of being elderly (40–59, 60–79 or 80+ years old) increases the possibility of death compared to hospitalized adults under 40 years of age. This finding is in line with those reported in other studies conducted for different countries [ 14 , 38 , 39 , 40 ], and it can be interpreted due to the influence of immunosenescence (immune aging), which negatively contributes to a low immune response to vaccination of the elderly. Notice that this immunological fact is not unique to anti-COVID-19 vaccines, occurring with influenza, pneumonia, tetanus, and hepatitis B vaccines as well [ 41 ].…”

Section: Discussionsupporting

confidence: 92%

Risk Factors Associated with Mortality in Hospitalized Patients with COVID-19 during the Omicron Wave in Brazil

et al. 2022

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Considering the imminence of new SARS-CoV-2 variants and COVID-19 vaccine availability, it is essential to understand the impact of the disease on the most vulnerable groups and those at risk of death from the disease. To this end, the odds ratio (OR) for mortality and hospitalization was calculated for different groups of patients by applying an adjusted logistic regression model based on the following variables of interest: gender, booster vaccination, age group, and comorbidity occurrence. A massive number of data were extracted and compiled from official Brazilian government resources, which include all reported cases of hospitalizations and deaths associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Brazil during the “wave” of the Omicron variant (BA.1 substrain). Males (1.242; 95% CI 1.196–1.290) aged 60–79 (3.348; 95% CI 3.050–3.674) and 80 years or older (5.453; 95% CI 4.966–5.989), and hospitalized patients with comorbidities (1.418; 95% CI 1.355–1.483), were more likely to die. There was a reduction in the risk of death (0.907; 95% CI 0.866–0.951) among patients who had received the third dose of the anti-SARS-CoV-2 vaccine (booster). Additionally, this big data investigation has found statistical evidence that vaccination can support mitigation plans concerning the current scenario of COVID-19 in Brazil since the Omicron variant and its substrains are now prevalent across the entire country.

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Section: Discussionsupporting

confidence: 92%

Risk Factors Associated with Mortality in Hospitalized Patients with COVID-19 during the Omicron Wave in Brazil

et al. 2022

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“…Interestingly, in our cohort of COVID-19 patients, APTT was not closely associated with severe prognosis, although coagulation dysfunction by increased APTT and D-dimer was previously correlated with disease progression towards severe conditions [23,25,47]. Our results are supported by a meta-analysis [24] that has shown normal values of APTT among severe cases.…”

Section: Discussionsupporting

confidence: 82%

Risk of Death in Comorbidity Subgroups of Hospitalized COVID-19 Patients Inferred by Routine Laboratory Markers of Systemic Inflammation on Admission: A Retrospective Study

Cocoș

Mahler

Turcu-Știolică

et al. 2022

Viruses

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Our study objective was to construct models using 20 routine laboratory parameters on admission to predict disease severity and mortality risk in a group of 254 hospitalized COVID-19 patients. Considering the influence of confounding factors in this single-center study, we also retrospectively assessed the correlations between the risk of death and the routine laboratory parameters within individual comorbidity subgroups. In multivariate regression models and by ROC curve analysis, a model of three routine laboratory parameters (AUC 0.85; 95% CI: 0.79–0.91) and a model of six laboratory factors (AUC 0.86; 95% CI: 0.81–0.91) were able to predict severity and mortality of COVID-19, respectively, compared with any other individual parameter. Hierarchical cluster analysis showed that inflammatory laboratory markers grouped together in three distinct clusters including positive correlations: WBC with NEU, NEU with neutrophil-to-lymphocyte ratio (NLR), NEU with systemic immune-inflammation index (SII), NLR with SII and platelet-to-lymphocyte ratio (PLR) with SII. When analyzing the routine laboratory parameters in the subgroups of comorbidities, the risk of death was associated with a common set of laboratory markers of systemic inflammation. Our results have shown that a panel of several routine laboratory parameters recorded on admission could be helpful for early evaluation of the risk of disease severity and mortality in COVID-19 patients. Inflammatory markers for mortality risk were similar in the subgroups of comorbidities, suggesting the limited effect of confounding factors in predicting COVID-19 mortality at admission.

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“…A combination of laboratory parameters indicative of acute inflammation (CRP), cell death (LDH), and hypercoagulable state (fibrinogen), showed good discrimination value for the development of critical COVID-19 in the derivation cohort, which was higher than any of the parameters alone. Our study is one of the very few available studies focusing on patients without pre-existing comorbidities [ 17 , 18 , 19 , 20 , 21 , 22 ] and, to the best of our knowledge, the first one that included patients who were uniformly treated with anticoagulants and corticosteroids/remdesivir in cases with oxygen desaturation [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, we show that a hypercoagulable state, as expressed by increased fibrinogen levels, is associated with critical disease development. Previous studies have also shown that hypercoagulability and thrombosis as expressed by prolonged activated partial thromboplastin time (aPTT) [ 20 ] or increased d-dimers [ 19 , 20 , 22 ] are associated with severe COVID-19 development among patients without comorbidities. A high rate of thromboses is observed among patients with COVID-19, while even patients who have been released from the hospital are in increased risk of thrombosis in the next months [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Increased LDH release in the circulation could reflect either direct infection of cells/tissues by SARS-CoV-2 or extensive tissue damage secondary to a strong systemic inflammatory response. Nevertheless, LDH seems to be an independent predictor for severe disease development and mortality consistently reported in patients without existing comorbidities [ 17 , 18 , 20 , 22 ], while it has not been included in COVID-19 risk scores such as the well-established 4C mortality score [ 2 ], which was developed based on mixed populations. This discrepancy further underlines the need to study patients without pre-existing comorbidities.…”

Section: Discussionmentioning

confidence: 99%

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A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected Patients

Georgakopoulou

Vlachogiannis

Basoulis

et al. 2022

JCM

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We aimed to search for laboratory predictors of critical COVID-19 in consecutive adults admitted in an academic center between 16 September 2020–20 December 2021. Patients were uniformly treated with low-molecular-weight heparin, and dexamethasone plus remdesivir when SpO2 < 94%. Among consecutive unvaccinated patients without underlying medical conditions (n = 241, 49 year-old median, 71% males), 22 (9.1%) developed critical disease and 2 died (0.8%). White-blood-cell counts, neutrophils, neutrophil-to-lymphocyte ratio, CRP, fibrinogen, ferritin, LDH and γ-GT at admission were each univariably associated with critical disease. ROC-defined cutoffs revealed that CRP > 61.8 mg/L, fibrinogen > 616.5 mg/dL and LDH > 380.5 U/L were each associated with critical disease development, independently of age, sex and days from symptom-onset. A score combining higher-than-cutoff CRP (0/2), LDH (0/1) and fibrinogen (0/1) predicted critical disease (AUC: 0.873, 95% CI: 0.820–0.926). This score performed well in an unselected patient cohort (n = 1228, 100% unvaccinated) predominantly infected by the alpha variant (AUC: 0.718, 95% CI: 0.683–0.753), as well as in a mixed cohort (n = 527, 65% unvaccinated) predominantly infected by the delta variant (AUC: 0.708, 95% CI: 0.656–0.760). Therefore, we propose that a combination of standard biomarkers of acute inflammatory response, cell death and hypercoagulability reflects the severity of COVID-19 per se independently of comorbidities, age and sex, being of value for risk stratification in unselected patients.

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Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities

Cited by 40 publications

References 44 publications

Risk Factors Associated with Mortality in Hospitalized Patients with COVID-19 during the Omicron Wave in Brazil

Risk Factors Associated with Mortality in Hospitalized Patients with COVID-19 during the Omicron Wave in Brazil

Risk of Death in Comorbidity Subgroups of Hospitalized COVID-19 Patients Inferred by Routine Laboratory Markers of Systemic Inflammation on Admission: A Retrospective Study

A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected Patients

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