Emergency room comprehensive assessment of demographic, radiological, laboratory and clinical data of patients with COVID-19: determination of its prognostic value for in-hospital mortality

Abstract

Mortality risk in COVID-19 patients is determined by several factors. The aim of our study was to adopt an integrated approach based on clinical, laboratory and chest x-ray (CXR) findings collected at the patient’s admission to Emergency Room (ER) to identify prognostic factors. Retrospective study on 346 consecutive patients admitted to the ER of two North-Western Italy hospitals between March 9 and April 10, 2020 with clinical suspicion of COVID-19 confirmed by reverse transcriptase-polymerase reaction chain test (RT-PCR), CXR performed within 24 h (analyzed with two different scores) and recorded prognosis. Clinical and laboratory data were collected. Statistical analysis on the features of 83 in-hospital dead vs 263 recovered patients was performed with univariate (uBLR), multivariate binary logistic regression (mBLR) and ROC curve analysis. uBLR identified significant differences for several variables, most of them intertwined by multiple correlations. mBLR recognized as significant independent predictors for in-hospital mortality age > 75 years, C-reactive protein (CRP) > 60 mg/L, PaO2/FiO2 ratio (P/F) < 250 and CXR “Brixia score” > 7. Among the patients with at least two predictors, the in-hospital mortality rate was 58% against 6% for others [p < 0.0001; RR = 7.6 (4.4–13)]. Patients over 75 years had three other predictors in 35% cases against 10% for others [p < 0.0001, RR = 3.5 (1.9–6.4)]. The greatest risk of death from COVID-19 was age above 75 years, worsened by elevated CRP and CXR score and reduced P/F. Prompt determination of these data at admission to the emergency department could improve COVID-19 pretreatment risk stratification.

The Role of Demographic, Clinical, and Laboratory Characteristics in Predicting the In-Hospital Outcomes of Patients With COVID-19

“…In addition, He et al found that patients had derangements in coagulation profile studies at the time of presentation [ 25 ]. However, not all laboratory findings were normal in our study; elevated levels of CRP and ferritin were noted in the initial measurements taken in the ED for the majority of our patients, which could be explained by the fact that the levels of these inflammatory markers could be influenced by disease activity early in the course of the disease, as mentioned by a few other papers [ 5 , 21 , 26 ].…”

“…However, some patients may present with non-specific symptoms, such as headache and dizziness [ 4 ]. Recent studies have shown that elderly patients with multiple comorbidities and high levels of inflammatory markers usually have a higher mortality risk than others [ 5 , 6 ]. A recent study published in March 2021 showed that male sex, lymphopenia, elevated C-reactive protein (CRP), and presence of comorbidities are all potential risk factors for poor outcomes in COVID-19 patients [ 7 ].…”

Variation in COVID-19 Disease Severity and Clinical Outcomes Between Different ABO Blood Groups

“…There are many significant factors that can play a major role in predicting COVID-19 outcomes, including sex, age, and clinical and laboratory findings [ 8 - 9 ]. In addition, comorbidities such as hypertension, diabetes mellitus, and asthma were among the strongest predictors of COVID-19 outcome.…”

Brixia and qSOFA Scores, Coagulation Factors and Blood Values in Spring versus Autumn 2021 Infection in Pregnant Critical COVID-19 Patients: A Preliminary Study

“…Balbi [ 43 ], d’Souza [ 44 ] and Au-Yong [ 45 ] correlated the Brixia A score with outcomes in COVID-19 patients. Setiawati [ 46 ] found that severe cases of COVID-19 pneumonia had a Brixia score over 6, Gatti [ 47 ] over 7 upon admission and Boari [ 48 ] over 8, but the first and last authors did not specify which Brixia score they used: A, H or E. Similarly, Hoang [ 49 ] and Gurtoo [ 50 ] also correlated Brixia score with the outcomes in COVID-19 patients but did not specify which Brixia score they used in calculations—either A, H or E score—or if there was more than one chest X-ray taken of each patient. In another study, Boari [ 51 ] even correlated the Brixia score with the lung involvement at the posthospitalization follow-up.…”