Predictors of fatality including radiographic findings in adults with COVID-19

Abstract

Background: Older age and elevated d-dimer are reported risk factors for coronavirus disease 2019 (COVID-19). However, whether early radiographic change is a predictor of fatality remains unknown. Methods: We retrospectively reviewed records of all laboratory-confirmed patients admitted to a quarantine unit at Tongji Hospital, a large regional hospital in Wuhan, China, between January 31 and March 5, 2020. Confirmed cases were defined by positive RT-PCR detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in throat-swab specimens. Chest CT images were reviewed independently by two radiologists. The Tongji Hospital ethics committee approved this study. Results: A total of 102 patients were confirmed to have SARS-CoV-2 infection. As of March 25, 85 confirmed patients were discharged, 15 died, and 2 remained hospitalized. When compared with survivors, non-survivors were older (median age, 69 [interquartile range, 58-77] vs. 55 [44-66], p = 0.003), and more likely to have decreased lymphocyte count (0.5 vs. 0.9 × 10 9 /L, p = 0.006), elevated lactate dehydrogenase (LDH) (569.0 vs. 272.0 U/L, p < 0.001), elevated d-dimer (> 1 μg/mL, 86% vs. 37%, p = 0.002) on admission. Older age and elevated LDH were independent risk factors for fatality in a multivariate regression model included the above variables. In a subset of patients with CT images within the first week, higher total severity score, and more involved lung lobes (5 involved lobes) in CT images within the first week were significantly associated with fatality. Moreover, in this subset of patients, higher total severity score was the only independent risk factor in a multivariate analysis incorporating the above mentioned variables. Conclusions: Older age, elevated LDH on admission, and higher severity score of CT images within the first week are potential predictors of fatality in adults with COVID-19. These predictors may help clinicians identify patients with a poor prognosis at an early stage.

Inflammatory phenotyping predicts clinical outcome in COVID-19

“…When the cohort as a whole was interrogated, the standard clinical demographics and NEWS2 score were accurate at predicting adverse outcome in patients with COVID-19 needing hospitalisation, with increasing age adding the greatest weight to this model. This is not unexpected and reflected in the literature, where in a large Wuhan cohort, older age, LDH and greater radiological change on computer tomography were predictive of poor outcome [ 18 ], and supports the use of the routine clinical tests that have evolved alongside our understanding of this novel disease in early stratification of patient risk as a clinical COVID-19 panel.…”

Determining extent of COVID-19 pneumonia on CT based on biological variables

“…These markers of severity could also help predicting disease worsening, which might occur after 7-10 days of evolution [22]. Elevated PCT, creatinine, amino transferase, cardiac troponin and D-dimers were also described as risk factors of critical Covid-19 infection [23].…”

Clinical and laboratory findings of COVID-19: A systematic review and meta-analysis

“… 53 a 26–95 65M 41 F a 40/106 (37.7) a a a a Li et al. 54 a 45–70 59 M 43 F 44 (43) 15 (15) 31 (30) 4 (4) 2 (2) Alsofayan et al. 55 a 14–66 825 M 694 F 36 (4.7) 1095 (72) 83 (5.46) 97 (6.4) 25 (1.6) 57 (3.75) No, number; ICU, intensive care unit; CVD, cardiovascular disease; COPD, chronic obstructive pulmonary disease; M, male; F, female.…”

“… 53 26/6/2020 Italy Cross-Sectional 106 11 Li et al. 54 11/6/2020 China Cohort, Retrospective 102 10 Alsofayan et al. 55 31/5/2020 KSA Cross-Sectional 1519 11 …”