Predictors of mortality among hospitalized COVID-19 patients and risk score formulation for prioritizing tertiary care—An experience from South India

Abstract

Background We retrospectively data-mined the case records of Reverse Transcription Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients hospitalized to a tertiary care centre to derive mortality predictors and formulate a risk score, for prioritizing admission. Methods and findings Data on clinical manifestations, comorbidities, vital signs, and basic lab investigations collected as part of routine medical management at admission to a COVID-19 tertiary care centre in Chengalpattu, South India between May and November 2020 were retrospectively analysed to ascertain predictors of mortality in the univariate analysis using their relative difference in distribution among ‘survivors’ and ‘non-survivors’. The regression coefficients of those factors remaining significant in the multivariable logistic regression were utilised for risk score formulation and validated in 1000 bootstrap datasets. Among 746 COVID-19 patients hospitalised [487 “survivors” and 259 “non-survivors” (deaths)], there was a slight male predilection [62.5%, (466/746)], with a higher mortality rate observed among 40–70 years age group [59.1%, (441/746)] and highest among diabetic patients with elevated urea levels [65.4% (68/104)]. The adjusted odds ratios of factors [OR (95% CI)] significant in the multivariable logistic regression were SaO2<95%; 2.96 (1.71–5.18), Urea ≥50 mg/dl: 4.51 (2.59–7.97), Neutrophil-lymphocytic ratio (NLR) >3; 3.01 (1.61–5.83), Age ≥50 years;2.52 (1.45–4.43), Pulse Rate ≥100/min: 2.02 (1.19–3.47) and coexisting Diabetes Mellitus; 1.73 (1.02–2.95) with hypertension and gender not retaining their significance. The individual risk scores for SaO2<95–11, Urea ≥50 mg/dl-15, NLR >3–11, Age ≥50 years-9, Pulse Rate ≥100/min-7 and coexisting diabetes mellitus-6, acronymed collectively as ‘OUR-ARDs score’ showed that the sum of scores ≥ 25 predicted mortality with a sensitivity-90%, specificity-64% and AUC of 0.85. Conclusions The ‘OUR ARDs’ risk score, derived from easily assessable factors predicting mortality, offered a tangible solution for prioritizing admission to COVID-19 tertiary care centre, that enhanced patient care but without unduly straining the health system.

Zonulin, a marker of gut permeability, is associated with mortality in a cohort of hospitalised peruvian COVID-19 patients

“…In addition, a lower Sa/FiO 2 ratio and a decreased lymphocyte count were associated with death by COVID-19 ( Henry et al., 2020 ; Huang and Pranata, 2020 ; Booth et al., 2021 ; Pons et al., 2021 ; Gopalan et al., 2022 ; Soto et al., 2022 ). It should be noted that lymphopenia might occur due to consequent apoptosis of activated CD4+T cells by SARS-CoV-2 ( Shen et al., 2022 ), thereby inducing immune suppression.…”

Risk of Death in Comorbidity Subgroups of Hospitalized COVID-19 Patients Inferred by Routine Laboratory Markers of Systemic Inflammation on Admission: A Retrospective Study

“…Elevated NLR has been used successfully as an independent prognostic parameter of bacterial infections treatment outcome [34,55], hypertension, heart failure or progression of cancer and response to drug therapy [56]. Endothelial cell death following cellular damage caused by viral infection may be indicated by elevated levels of NLR due to various inflammatory cells, including neutrophils, which in turn leads to multisystemic inflammation by secreting large quantities of cytokines [46,57].…”

“…In our opinion, compared to the prognosis of COVID-19 severity with scoring systems, the prediction utility of the published models of prognosis based strictly on laboratory parameters is not limited by the clinical data which might be unavailable for nonsevere patients at admission [82]. Moreover, such models could be more appropriate for prediction of all clinical outcomes considering that multiple-organ damage is more pronounced in nonsurvivors and the individual relevance of the components of risk scores in the prediction of mortality, such as the levels of SaO2 at admission [57,82].…”

Lack of Correlation Between Soluble Angiotensin-Converting Enzyme 2 and Inflammatory Markers in Hospitalized COVID-19 Patients with Hypertension

“… 45 , 46 Yet; several studies suggested that rather than a single parameter, multiple markers should be used as predictors of severity and mortality in patients with COVID-19. 47 , 48 …”

“…45,46 Yet; several studies suggested that rather than a single parameter, multiple markers should be used as predictors of severity and mortality in patients with COVID-19. 47,48 Regardless of all the above findings, the incomplete knowledge of the association between COVID and ACE2 has led to debates concerning the use of RAAS inhibitors. Our study found no concern regarding the inflammatory markers; we even found a better ratio of IL-6/IL-10 in patients treated with RAAS inhibitors.…”