Risk factors for mortality among patients with SARS‐CoV‐2 infection: A longitudinal observational study

Abstract

Background Recent literature suggests that approximately 5‐18% of patients diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) may progress rapidly to a severe form of the illness and subsequent death. We examined the relationship between sociodemographic, clinical, and laboratory findings with mortality among patients. Methods In this study, 112 patients were evaluated from February‐May 2020 and 80 patients met the inclusion criteria. Tocilizumab (TCZ) was administered, followed by methylprednisolone to patients with pneumonia severity index (PSI) score ≤ 130 and CT scan changes. Demographic data and clinical outcomes were collected. Laboratory biomarkers were monitored during hospitalization. Statistical analyses were performed with significance p≤ 0.05. Results Eighty (80) patients: 45 males (56.25%) and 35 females (43.75%) met the study inclusion criteria. Seven patients (8.75%) were deceased. An increase in mortality outcome was statistically significantly associated with higher average levels of IL‐6 with P value (0.050), and D‐dimer with P value (0.024). Bivariate logistics regression demonstrated a significant increased odds for mortality for patients with bacterial lung infections (OR: 10.83, 95% CI: 2.05 – 57.40, P=0.005 ) and multi‐organ damage (OR: 103.50, 95% CI: 9.92 – 1079.55, P=0.001 ). Multivariate logistics regression showed a statistically significant association for multi‐organ damage (AOR: 94.17, 95% CI: 7.39 ‐ 1200.78, P=0.001 ). Conclusions We identified three main predictors for high mortality. These include interleukin‐6 (IL‐6), D‐dimer, and multi‐organ damage. The latter was the highest potential risk for in‐hospital deaths. This warrants aggressive health measures for early recognition of the problem and initiation of treatment to reverse injuries. This article is protected by copyright. All rights reserved.

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

“…The association of selected demographic and laboratory features with outcome has been confirmed by many studies [ 3 , 5 , 7 – 9 , 11 , 13 , 15 ]. Anemia in patients with SARS-CoV-2 infection could be present before the onset of infection due to chronic illness, especially malignancy.…”

“…In the era of the COVID-19 pandemic, numerous models for predicting in-hospital mortality have been developed [ 7 – 20 ]. They are typically based on such data as age, sex, selected aspects of the treatments used, comorbidities, as well as imaging and laboratory findings.…”

Thyroid and COVID-19: a review on pathophysiological, clinical and organizational aspects

“…The relationship between severe COVID-19 and the low T3 syndrome is mostly attributable to systemic inflammation [57]. It should be considered that high levels of IL-6 are related to a poorer prognosis of COVID-19 patients, mostly due to a much extent of respiratory involvement [58][59][60]. IL-6 seems to suppress the production of free levothyroxine (fT4) and free triiodothyronine (fT3) and is implicated in the pathogenesis of the low T3 syndrome [61,62].…”

COVID-19 and the Endocrine System: A Comprehensive Review on the Theme

“…More recently, the NTIS on admission was found to predict clinical deterioration also in mild or moderate COVID-19 cases irrespective to SARS-CoV-2 viral load, age, and biomarkers of inflammation and tissue damage [112]. Hence, the clinical matter is whether the NTIS may be only a biomarker or, rather, it could serve as a risk factor for poor prognosis in septic patients [113][114][115]. The results of phase II, multicenter, prospective, randomized, double-blind, placebo-controlled trials in COVID-19 patients will provide a possible answer to this question [116].…”