Multidimensional Evaluation of All-Cause Mortality Risk and Survival Analysis for Hospitalized Patients with COVID-19

Abstract

Background: Coronavirus disease 2019 (COVID-19) has caused over 3.8 million deaths globally. Up to date, the number of death in 2021 is more than that in 2020 globally. Here, we aimed to compare clinical characteristics of deceased patients and recovered patients, and analyze the risk factors of death to help reduce mortality of COVID-19. Methods: In this retrospective study, a total of 2719 COVID-19 patients were enrolled, including 109 deceased patients and 2610 recovered patients. Medical records of all patients were collected between February 4, 2020, and April 7, 2020. Clinical characteristics, laboratory indices, treatments, and deep-learning system-assessed lung lesion volumes were analyzed. The effect of different medications on survival time of fatal cases was also investigated. Results: The deceased patients were older (73 years versus 60 years) and had a male predominance. Nausea (10.1% versus 4.1%) and dyspnea (54.1% versus 39.2%) were more common in deceased patients. The proportion of patients with comorbidities in deceased patients was significantly higher than those in recovered patients. The median times from hospital admission to outcome in deceased patients and recovered patients were 9 days and 13 days, respectively. Patients with severe or critical COVID-19 were more frequent in deceased group. Leukocytosis (11.35×10 9 /L versus 5.60×10 9 /L) and lymphocytopenia (0.52×10 9 /L versus 1.58×10 9 /L) were shown in patients who died. The level of prothrombin time, activated partial prothrombin time, D-dimer, aspartate aminotransferase, alanine aminotransferase, urea, creatinine, creatine kinase, glucose, brain natriuretic peptide, and inflammatory indicators were significantly higher in deceased patients than in recovered patients. The volumes of ground-glass, consolidation, total lesions and total lung in all patients were quantified. Complications were more common in deceased patients than in recovered patients; respiratory failure (57.8%), septic shock (36.7%), and acute respiratory distress syndrome (26.6%) were the most common complications in patients who died. Many treatments were more frequent in deceased patients, such as antibiotic therapy (88.1% versus 53.7%), glucocorticoid treatment (70.6% versus 11.0%), intravenous immunoglobin treatment (36.6% versus 4.9%), invasive mechanical ventilation (62.3% versus 3.8%). Antivirals, antibiotics, traditional Chinese medicines and glucocorticoid treatment may significantly increase the survival time of fatal cases. Quantitative computed tomography imaging results were correlated with biochemical markers.

Association of d-dimer levels with in-hospital outcomes among COVID-19 positive patients: a developing country multicenter retrospective cohort

“…In an observational study from China, the mean d-dimer concentration was significantly higher in nonsurvivors compared with survivors 16 . Similarly, another retrospective Chinese study showed elevated levels of d-dimer (5.35 mg/l vs. 0.98 mg/l) in deceased patients as compared to the survivors of COVID-19 17 . Several studies have corroborated that elevated levels of d-dimer levels are associated with disease severity and mortality rates 6 , 9 .…”

Prognostic value of glucose‐to‐lymphocyte ratio in critically ill patients with acute respiratory distress syndrome: A retrospective cohort study

“…It has been demonstrated that metabolic abnormalities are positively correlated with the severity and prognosis of patients with ARDS. Furthermore, elevated blood glucose level is an independent risk factor for predicting the prognosis of ARDS patients 29,30 . Moreover, hyperglycemia at admission is positively associated with poor outcomes of patients in ICU 31 .…”

“…Furthermore, elevated blood glucose level is an independent risk factor for predicting the prognosis of ARDS patients. 29 , 30 Moreover, hyperglycemia at admission is positively associated with poor outcomes of patients in ICU. 31 On the other hand, lymphocytes are indicators of immunity and their suppression shows a damaged immune system.…”

Septic shock in adults: guidelines of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists”

“…Летальность пациентов с сепсисом и ПОН в ОРИТ до стигает 50 % [44][45][46][47]. В период пандемии коронавирус ной инфекции летальность при развитии СШ превыша ла 80 % [48,49]. Таким образом, актуальность проблемы очевидна; в связи c этим целью данных клинических рекомендаций стала разработка мер по улучшению диагностики и результатов лечения СШ.…”