Patients’ treatment limitations as predictive factor for mortality in COVID-19: results from hospitalized patients of a hotspot region for SARS-CoV-2 infections

Abstract

Background In hospitalized patients with SARS-CoV-2 infection, outcomes markedly differ between locations, regions and countries. One possible cause for these variations in outcomes could be differences in patient treatment limitations (PTL) in different locations. We thus studied their role as predictor for mortality in a population of hospitalized patients with COVID-19. Methods In a region with high incidence of SARS-CoV-2 infection, adult hospitalized patients with PCR-confirmed SARS-CoV-2 infection were prospectively registered and characterized regarding sex, age, vital signs, symptoms, comorbidities (including Charlson comorbidity index (CCI)), transcutaneous pulse oximetry (SpO2) and laboratory values upon admission, as well as ICU-stay including respiratory support, discharge, transfer to another hospital and death. PTL assessed by routine clinical procedures comprised the acceptance of ICU-therapy, orotracheal intubation and/or cardiopulmonary resuscitation. Results Among 526 patients included (median [quartiles] age 73 [57; 82] years, 47% female), 226 (43%) had at least one treatment limitation. Each limitation was associated with age, dementia and eGFR (p < 0.05 each), that regarding resuscitation additionally with Charlson comorbidity index (CCI) and cardiac disease. Overall mortality was 27% and lower (p < 0.001) in patients without treatment limitation (12%) compared to those with any limitation (47%). In univariate analyses, age and comorbidities (diabetes, cardiac, cerebrovascular, renal, hepatic, malignant disease, dementia), SpO2, hemoglobin, leucocyte numbers, estimated glomerular filtration rate (eGFR), C-reactive protein (CRP), Interleukin-6 and LDH were predictive for death (p < 0.05 each). In multivariate analyses, the presence of any treatment limitation was an independent predictor of death (OR 4.34, 95%-CI 2.10–12.30; p = 0.001), in addition to CCI, eGFR < 55 ml/min, neutrophil number > 5 G/l, CRP > 7 mg/l and SpO2 < 93% (p < 0.05 each). Conclusion In hospitalized patients with SARS-CoV-2, the percentage of patients with treatment limitations was high. PTL were linked to age, comorbidities and eGFR assessed upon admission and strong, independent risk factors for mortality. These findings might be useful for further understanding of COVID-19 mortality and its regional variations. Clinical trial registration ClinicalTrials.gov Identifier: NCT04344171

Associations of Post-Acute COVID syndrome with physiological and clinical measures 10 months after hospitalization in patients of the first wave

“…In total, we thus had data from 155 of 252 patients included in the study (62%). Data on the hospital stay were taken from COVID-DB-project [9,42]. Written informed consent was obtained from all participants attending the inpatient assessment, whereas verbal informed consent was obtained from those contacted via phone.…”

“…The physical examination comprised a complete physical examination according to the standards of Internal Medicine and included the assessment of blood pressure, heart rate and oxygen saturation (SpO 2 ) by pulse oximetry at rest. Data on COVID-19 were taken from previous work [9,42]. The analysis of chest computer tomography (CT) scans was performed by an experienced radiologist following guidelines [46].…”

“…The spectrum of clinical signs and manifestations ranges from asymptomatic, mild influenza-like signs such as fever, cough and sore throat to severe pneumonias with respiratory failure, multi-organ failure and death [3][4][5][6][7][8]. Age and comorbidities are the most important risk factors for a clinically severe course or death [9][10][11]. The Bavarian region of Rosenheim was among the German hotspots in the first wave, and from March to June 2020, 526 patients were hospitalized in three hospitals of the RoMed health care provider.…”

“…The Bavarian region of Rosenheim was among the German hotspots in the first wave, and from March to June 2020, 526 patients were hospitalized in three hospitals of the RoMed health care provider. Of these, in total 27% died, specifically 20% of patients treated on normal wards and 49% of patients of intensive care units (ICU) [9].…”

Coronavirus Disease (COVID-19) Control between Drug Repurposing and Vaccination: A Comprehensive Overview

“…It provides an FDA-approved drug to be used for another new disease as an emergency plan. On the other hand, there is a big controversy in the outcome of the therapy used in treating COVID-19 patients, which might be different from one population to another and from one country to another [142]. This different treatment outcome is associated with many factors including comorbidity factors, environmental factors, and host factors [143,144].…”