Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan

Abstract

Background: In December 2019, the coronavirus disease 2019 (COVID-19) outbreak occurred in Wuhan. Data on the clinical characteristics and outcomes of patients with severe COVID-19 are limited. Objective: We sought to evaluate the severity on admission, complications, treatment, and outcomes of patients with COVID-19. Methods: Patients with COVID-19 admitted to Tongji Hospital from January 26, 2020, to February 5, 2020, were retrospectively enrolled and followed-up until March 3, 2020. Potential risk factors for severe COVID-19 were analyzed by a multivariable binary logistic model. Cox proportional hazard regression model was used for survival analysis in severe patients. Results: We identified 269 (49.1%) of 548 patients as severe cases on admission. Older age, underlying hypertension, high cytokine levels (IL-2R, IL-6, IL-10, and TNF-a), and high lactate dehydrogenase level were significantly associated with severe COVID-19 on admission. The prevalence of asthma in patients with COVID-19 was 0.9%, markedly lower than that in the adult population of Wuhan. The estimated mortality was 1.1% in nonsevere patients and 32.5% in severe cases during the average 32 days of follow-up period. Survival analysis revealed that male sex, older age, leukocytosis, high lactate dehydrogenase level, cardiac injury, hyperglycemia, and highdose corticosteroid use were associated with death in patients with severe COVID-19.Conclusions: Patients with older age, hypertension, and high lactate dehydrogenase level need careful observation and early intervention to prevent the potential development of severe COVID-19. Severe male patients with heart injury, hyperglycemia, and high-dose corticosteroid use may have a high risk of death.

Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis

“…Our search for COVID-19, SARS and MERS identified 5120 citations. After removing duplicates, screening titles and abstracts, and reviewing full texts, we ultimately included 1 cohort study 8 including 84 patients with COVID-19 and ARDS, 5 cohort studies [19][20][21][22][23] including 679 patients with COVID-19 but without ARDS, 3 studies (2 cohort studies 24,25 and 1 RCT 26 ) including 7087 patients with SARS, and 2 cohort studies 27,28 including 623 patients with MERS.…”

“…Very low-quality evidence from 2 cohort studies 19,23 including 331 patients with severe COVID-19 raised the possibility that corticosteroids may increase mortality compared with no corticosteroids (HR 2.30, 95% CI 1.00 to 5.29, MD 11.9% more) (Table 3, Figure 2). One cohort study 20 reported an increase in the composite outcome of mortality or ICU admission with steroid use.…”

Lessons Learned from COVID-19 Pandemic in Italy

“…Instead, it is necessary to empower territorial medicine allowing general practitioners to go to the patients' home with proper personal protective equipment (PPE) to perform SARS-CoV-2 swab at home and identify and isolate positive subjects at an early stage. Individual isolation and early medical therapy may allow the prevention of severe pulmonary complications that require hospitalization and intensive care and limit the spread of the infection [11].…”

Allergen Immunotherapy in the Era of SARS-CoV-2

“…The binding receptor of SARS-CoV-2 has been identified in the angiotensin converting enzyme (ACE)-2 and a Th-1 cytokine storm (IL-6 and TNF-α) sustains the lung inflammation of COVID-19, thus it is not expected a direct protective effect of AIT. Speculatively, the predominant Th-2 immune response in allergic patients might be beneficial and counter the inflammation process induced by SARS-CoV-2 [6]. Conversely, the therapeutic weapons fighting a Th-2 response, including AIT, could work indirectly by contributing to restore an impaired broad antiviral response.…”

“…J Investig Allergol Clin Immunol 2020; Vol. 30(6) © 2020 Esmon Publicidad doi: 10.18176/jiaci.0568 AIT for years has been predominantly administered subcutaneously (SCIT), with periodic injections in a continuous schedule along the year or clustered preseasonal approaches. SCIT is safe provided adequate precautions are taken in a supervised facility, with properly trained staff and equipment to immediately manage severe reactions.…”