Risk factors for mortality of coronavirus disease-2019 (COVID-19) patients in two centers of Hubei province, China: A retrospective analysis

Abstract

Purpose Since the outbreak in late December 2019 in Wuhan, China, coronavirus disease-2019 (COVID-19) has become a global pandemic. We analyzed and compared the clinical, laboratory, and radiological characteristics between survivors and non-survivors and identify risk factors for mortality. Methods Clinical and laboratory variables, radiological features, treatment approach, and complications were retrospectively collected in two centers of Hubei province, China. Cox regression analysis was conducted to identify the risk factors for mortality. Results A total of 432 patients were enrolled, and the median patient age was 54 years. The overall mortality rate was 5.09% (22/432). As compared with the survivor group (n = 410), those in the non-survivor group (n = 22) were older, and they had a higher frequency of comorbidities and were more prone to suffer from dyspnea. Several abnormal laboratory variables indicated that acute cardiac injury, hepatic damage, and acute renal insufficiency were detected in the non-survivor group. Non-surviving patients also had a high computed tomography (CT) score and higher rate of consolidation. The most common complication causing death was acute respiratory distress syndrome (ARDS) (18/22, 81.8%). Multivariate Cox regression analysis revealed that hemoglobin (Hb) <90 g/L (hazard ratio, 10.776; 95% confidence interval, 3.075–37.766; p<0.0001), creatine kinase (CK-MB) >8 U/L (9.155; 2.424–34.584; p = 0.001), lactate dehydrogenase (LDH) >245 U/L (5.963; 2.029–17.529; p = 0.001), procalcitonin (PCT) >0.5 ng/ml (7.080; 1.671–29.992; p = 0.008), and CT score >10 (39.503; 12.430–125.539; p<0.0001) were independent risk factors for the mortality of COVID-19. Conclusions Low Hb, high LDH, PCT, and CT score on admission were the predictors for mortality and could assist clinicians in early identification of poor prognosis among COVID-19 patients.

Serum CK-MB, COVID-19 severity and mortality: An updated systematic review and meta-analysis with meta-regression

“…Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and the direction of the effect size were not influenced (effect size range, between 0.77 and 0.84) ( Figure 4 ). CK-MB concentrations remained statistically significantly higher (SMD 0.72, 95% CI 0.54 to 0.90, p<0.001; I 2 =90.2%, p<0.001) in patients with high severity or non-survivor status after excluding 5 relatively large studies that accounted for nearly 28% of the overall sample size [ 36 , 58 , 67 , 78 , 83 ].

Figure 4 Sensitivity analysis of the association between CK-MB and COVID-19 disease.

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“…Two studies were conducted in Turkey [ 34 , 58 ], 1 in the USA [ 57 ], 1 in Korea [ 52 ], and the remaining 51 in China [ 14 , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [53] , [54] , [55] , [56] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] ]. Three studies were prospective [ 42 , 53 , 68 ], 47 retrospective [ [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ...…”

“…Three studies were prospective [ 42 , 53 , 68 ], 47 retrospective [ [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [43] , [44] , [45] , [46] , [47] , [48] , [50] , [51] , [52] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , 67 , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , 87 ], whereas the remaining 5 did not report information regarding the study design [ 14 , 49 , 66 , 71 , 86 ]. Clinical endpoints included disease severity based on current clinical guidelines in 21 studies [ 38 , 43 , 45 , [48] , [49] , [50] , [51] , [52] , 54 ...…”

“…In particular, a sub-group of 13 retrospective studies conducted in China [ 40 , 44 , 47 , 55 , 62 , 69 , 73 , [75] , [76] , [77] , 81 , 83 , 87 ] assessed survival and measured CK-MB using an assay based on activity evaluation. Funnel plot analysis showed that 3 of these studies were located outside of the plot ( Figure 8 A) [ 62 , 77 , 83 ]. After removing these studies, the effect size of the remaining 10 studies confirmed that the CK-MB concentrations were statistically significantly higher in patients with high disease severity or non-survivor status during follow up (SMD 0.97, 95% CI 0.84 to 1.09, p<0.001) ( Figure 8 B).…”

Cystatin C, COVID-19 severity and mortality: a systematic review and meta-analysis

“…Eleven studies were retrospective [ 30 – 32 , 34 – 37 , 39 – 42 ], whilst the remaining two were prospective [ 33 , 38 ]. Endpoints included disease severity based on current clinical guidelines (8 studies) [ 31 , 33 – 35 , 37 , 39 , 40 , 42 ], disease progression (one study) [ 38 ] and occurrence of acute respiratory distress syndrome (ARDS) (one study) [ 36 ], and survival status (4 studies) [ 30 , 32 , 36 , 41 ]. Only two studies reported the presence of AKI [ 32 , 39 ].…”