Clinical Features and Risk Factors for In-Hospital Mortality From COVID-19 Infection at a Tertiary Care Medical Center, at the Onset of the US COVID-19 Pandemic

Abstract

Background: Mortality from COVID-19 has been associated with older age, black race, and comorbidities including obesity, Understanding the clinical risk factors and laboratory biomarkers associated with severe and fatal COVID-19 will allow early interventions to help mitigate adverse outcomes. Our study identified risk factors for in-hospital mortality among patients with COVID-19 infection at a tertiary care center, in Detroit, Michigan. Methods: We conducted a single-center, retrospective cohort study at a 776-bed tertiary care urban academic medical center. Adult inpatients with confirmed COVID-19 (nasopharyngeal swab testing positive by real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay) from March 8, 2020, to June 14, 2020, were included. Clinical information including the presence of comorbid conditions (according to the Charlson Weighted Index of Comorbidity (CWIC)), initial vital signs, admission laboratory markers and management data were collected. The primary outcome was in-hospital mortality. Results: Among 565 hospitalized patients, 172 patients died for a case fatality rate of 30.4%. The mean (SD) age of the cohort was 64.4 (16.2) years, and 294 (52.0%) were male. The patients who died were significantly older (mean [SD] age, 70.4 [14.1] years vs 61.7 [16.1] years; P < 0.0001), more likely to have congestive heart failure (35 [20.3%] vs 47 [12.0%]; P = 0.009), dementia (47 [27.3%] vs 48 [12.2%]; P < 0.0001), hemiplegia (18 [10.5%] vs 18 [4.8%]; P = 0.01) and a diagnosis of malignancy (16 [9.3%] vs 18 [4.6%]; P = 0.03).From multivariable analysis, factors associated with an increased odds of death were age greater than 60 years (OR = 2.2, P = 0.003), CWIC score (OR = 1.1, P = 0.023), qSOFA (OR = 1.7, P < 0.0001), WBC counts (OR = 1.1 , P = 0.002), lymphocytopenia (OR = 2.0, P = 0.003), thrombocytopenia (OR = 1.9, P = 0.019), albumin (OR = 0.6 , P = 0.014), and AST levels (OR = 2.0, P = 0.004) on admission. Conclusions: This study identified risk factor for in-hospital mortality among patients admitted with COVID-19 in a tertiary care hospital at the onset of U.S. Covid-19 pandemic. After adjusting for age, CWIC score, and laboratory data, qSOFA remained an independent predictor of mortality. Knowing these risk factors may help identify patients who would benefit from close observations and early interventions.

Clinical Profile and Determinants of Mortality in Patients With COVID-19: A Retrospective Analytical Cross-Sectional Study in a Tertiary Care Center in South India

“…The less common symptoms were myalgia, sore throat, headache, fatigue, rhinitis, loose stools, vomiting, and anosmia. More patients reported complaints of breathlessness along with fever and cough, compared to other studies [19,20]. The probable reason could be that ours being a referral center, many patients might have been admitted days after the onset of disease.…”

“…This is in line with the higher in-hospital case fatality rate in referral tertiary care centers compared to the general population. A tertiary care medical center in the USA, which also had a high proportion of patients with comorbidities (95.2%), reported a case fatality rate of 30% during the early phase of the pandemic [19].…”

Effects of SARS-CoV-2 infections in patients with cancer on mortality, ICU admission and incidence: a systematic review with meta-analysis involving 709,908 participants and 31,732 cancer patients

“…After a preliminary review and the elimination of duplicates, 5328 papers were screened and chosen for further evaluation. A total of 58 studies (Adejumo et al 2021 ; Akhtar et al 2021 ; Alpert et al 2021 ; Arslan et al 2021 ; Azarkar et al 2021 ; Baker et al 2021 ; Benelli et al 2020 ; Bennett et al 2021 ; Bergman et al 2021 ; Bernard et al 2021 ; Bhargava et al 2021 ; Borobia et al 2020 ; Pinto et al 2020 ; Chai et al 2021 ; Fu et al 2021 ; Chudasama et al 2021 ; Costa et al 2021 ; Duanmu et al 2020 ; Gold et al 2020 ; Görgülü et al 2020 ; Goyal et al 2020 ; Gude-Sampedro et al 2021 ; Guo et al 2021 ; Joharatnam-Hogan et al 2020 ; Katkat et al 2021 ; Kim et al 2021 ; Kokturk et al 2021 ; Liang et al 2021 ; Sun et al 2021 ; Cavanna et al 2020 ; Lunski et al 2021 ; Martinot et al 2021 ; Mirgh et al 2021 ; Miyashita et al 2020 ; Nakamura et al 2021 ; Nikpouraghdam et al 2020 ; Panda et al 2022 ; Péron et al 2021 ; Poli et al 2022 ; Li et al 2020a , b ; Reddy et al 2021 ; Regina et al 2020 ; Ricoca-Peixoto et al 2020 ; Giorgi-Rossi et al 2020 ; Rugge et al 2020 ; Erdal et al 2021 ; Sami et al 2020 ; Santorelli et al 2021 ; Pérez-Segura et al 2021 ; Serraino et al 2021 ; Shahidsales et al 2021 ; Sorouri et al 2020 ; Stroppa et al 2020 ; Tehrani et al 2021 ; Vergara et al 2021 ; Vila-Corcoles et al 20...…”

“…A total of 42 studies (Akhtar et al 2021 ; Alpert et al 2021 ; Arslan et al 2021 ; Azarkar et al 2021 ; Baker et al 2021 ; Benelli et al 2020 ; Bennett et al 2021 ; Bernard et al 2021 ; Bhargava et al 2021 ; Borobia et al 2020 ; Pinto et al 2020 ; Chai et al 2021 ; Fu et al 2021 ; Gude-Sampedro et al 2021 ; Guo et al 2021 ; Joharatnam-Hogan et al 2020 ; Katkat et al 2021 ; Kim et al 2021 ; Kokturk et al 2021 ; Liang et al 2021 ; Sun et al 2021 ; Lunski et al 2021 ; Martinot et al 2021 ; Mirgh et al 2021 ; Miyashita et al 2020 ; Péron et al 2021 ; Poli et al 2022 ; Li et al 2020a , b ; Reddy et al 2021 ; Ricoca Peixoto et al 2020 ; Giorgi-Rossi et al 2020; Rugge et al 2020 ; Erdal et al 2021 ; Pérez-Segura et al 2021 ; Serraino et al 2021 ; Shahidsales et al 2021 ; Sorouri et al 2020 ; Stroppa et al 2020 ; Vergara et al 2021 ; Vila-Corcoles et al 2021 ; Zhang et al 2021 ; Zhou et al 2021 ) were included in the analysis to compare the mortality rates of cancer and non-cancer patients infected with SARS-CoV-2. There were a total of 557,053 participants, of whom 21,599 were cancer patients.…”

Six-Month Post-Acute COVID-19: High Self-Reported Morbidity Among Adults Younger Than Sixty Years and Females

“…From a historical cohort study of hospitalized COVID-19 patients in our hospital, we identified patients discharged home, between March 8 and June 14, 2020 [ 5 ]. COVID-19 was confirmed via reverse transcriptase-polymerase chain reaction assay of a nasopharyngeal swab.…”