Influence factors of death risk among COVID-19 patients in Wuhan, China: a hospital-based case-cohort study

Abstract

In this hospital-based case-cohort study, we found that serum urea nitrogen, TBIL, LDH and AST/ALT ratio, several markers of extrapulmonary organ injuries, were positively correlated with death risk of COVID-19 patients. We provide evidence for the first time that multiple organ damage on admission influences the prognosis of COVID-19 patients. Early hospitalization is beneficial for elevating the survival rate of COVID-19 patients especially critical ill patients. AbstractBackground. Coronavirus disease 2019 (COVID-19) triggered by infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been widely pandemic all over the world. The aim of this study was to analyze the influence factors of death risk among 200 COVID-19 patients. Methods. Two hundred patients with confirmed SARS-CoV-2 infection were recruited. Demographic data and clinical characteristics were collected from electronic medical records. Biochemical indexes on admission were measured and patient's prognosis was tracked. The association of demographic data, clinical characteristics and biochemical indexes with death risk was analyzed. Results. Of 200 COVID-19 patients, 163 (81.5%) had at least one of comorbidities, including diabetes, hypertension, hepatic disease, cardiac disease, chronic pulmonary disease and others. Among all patients, critical cases, defined as oxygenation index lower than 200, accounted for 26.2%. Severe cases, oxygenation index from 200 to 300, were 29.7%. Besides, common cases, oxygenation index higher than 300, accounted for 44.1%. At the end of follow-up, 34 (17%) were died on mean 10.9 day after hospitalization. Stratified analysis revealed that older ages, lower oxygenation index and comorbidities elevated death risk of COVID-19 patients. On admission, 85.5%COVID-19 patients were with at least one of extrapulmonary organ injuries.Univariable logistic regression showed that ALT and TBIL, two indexes of hepatic injury, AST, myoglobin and LDH, AST/ALT ratio, several markers of myocardial injury, creatinine, urea nitrogen and uric acid, three indexes of renal injury, were positively associated with death risk of COVID-19 patients. Multivariable logistic regression revealed that AST/ALT ratio, urea nitrogen, TBIL and LDH on admission were positively correlated with death risk of COVID-19 patients. : medRxiv preprint significance to prevent multiple organ damage and improve the survival of COVID-19 patients. : medRxiv preprint RR was 3.698 (95% Cl: 0.825, 16.574; P=0.062) in COVID-19 patients between 50 and 59 years old, 2.907 (95% Cl: 0.632, 13.359; P=0.145) in patients between 60 and 69 years old, and 10.679 (95% Cl: 2.624, 43.459; P＜0.001) in patients over 70 years old, respectively. The relationship between oxygenation index and death risk of COVID-19 patients was analyzed. As shown in Table 1, the fatality rate was 52.9% in critical ill cases, 6.90% in severe cases, and 3.49% in common cases, respectively. The RR was 15.176 (95% Cl: 4.847, 47.519; P＜0.001) in critical ill cases with COVID-19 and 4...

Acute liver injury and its association with death risk of patients with COVID-19: a hospital-based prospective case-cohort study

“…Accumulating data indicate that SARS-CoV-2 infection causes multiple organ injuries, such as lymphopenia, myocardial dysfunction and acute renal failure [9,[15][16][17]25]. In the present study, we showed that oxygenation index, an index of respiratory function, was positively correlated with serum albumin.…”

“…The present study aimed to analyze SARS-CoV-2-induced ALI, its association with death risk and the prognosis after discharge. The major findings of this study include: (1) ALI is more common in the critically ill COVID-19 patients; (2) Accumulating data demonstrated that SARS-CoV-2 infection caused multiple organ injuries, including myocardial dysfunction, lymphopenia and even acute renal failure [15][16][17]. In the present study, we described ALI among COVID-19 patients.…”

Myocardial Injury at Early Stage and Its Association with Death Risk of Patients with COVID-19: A Hospital-Based Prospective Case-Cohort Study

“…Evidence pointing to the person-to-person transmission has occurred among close contacts in hospital and family [6]. As reported by other researchers and our team found that patients with COVID-19 present primarily with fever, diarrhea, fatigue, dry cough, lymphopenia and radiographic evidence of pneumonia [7][8][9]. The Chinese Center for Disease Control and Prevention recently revealed that the death risk of mild COVID-19 patients was relatively low in a large Chinese population-based study, the fatality rate was signi cantly elevated among critical ill COVID-19 cases [10].…”

High Aspartate Aminotransferase to Alanine Aminotransferase Ratio on Admission as Risk Factor for Poor Prognosis in COVID-19 Patients

“…Among a variety of recent publications about COVID-19, accumulated evidence suggests that SARS-CoV-2 infections might cause multiple and systemic injuries, including acute renal failure, myocardial dysfunction, and acute liver injury 20,24,25 . Additionally, there are recent studies analyzing COVID-19 patients in detail with respect to liver enzymes, such as ALT and AST 20,26 .…”