Risk factors for clinical deterioration in patients admitted for COVID-19: A case-control study

Abstract

Introduction There is controversy regarding the best predictors of clinical deterioration in COVID-19. Objective This work aims to identify predictors of risk factors for deterioration in patients hospitalized due to COVID-19. Methods design Nested case-control study within a cohort. Setting: 13 acute care centers of the Osakidetza-Basque Health Service. Participants: Patients hospitalized for COVID-19 with clinical deterioration—defined as onset of severe ARDS, ICU admission, or death—were considered cases. Two controls were matched to each case based on age. Sociodemographic data; comorbidities; baseline treatment; symptoms; date of onset; previous consultations; and clinical, analytical, and radiological variables were collected. An explanatory model of clinical deterioration was created by means of conditional logistic regression. Results A total of 99 cases and 198 controls were included. According to the logistic regression analysis, the independent variables associated with clinical deterioration were: emergency department O 2 saturation ≤90% (OR 16.6; 95%CI 4–68), pathological chest X-ray (OR 5.6; 95%CI 1.7–18.4), CRP > 100 mg/dL (OR 3.62; 95%CI 1.62–8), thrombocytopenia with <150,000 platelets (OR 4; 95%CI 1.84–8.6); and a medical history of acute myocardial infarction (OR 15.7; 95%CI, 3.29–75.09), COPD (OR 3.05; 95%CI 1.43-6.5), or HT (OR 2.21; 95%CI 1.11–4.4). The model’s AUC was 0.86. On the univariate analysis, female sex and presence of dry cough and sore throat were associated with better clinical progress, but were not found to be significant on the multivariate analysis. Conclusion The variables identified could be useful in clinical practice for the detection of patients at high risk of poor outcomes.

Predictors to Intensive Care Unit admission among patient with coronavirus disease in Sukraraj Tropical and Infectious Disease Hospital, Nepal: A case-control study

“…These findings were consistent with a recent studies conducted in China and United States, where no association was found between co-morbidities and ICU admission [2,17]. Consistent findings were found in another study conducted in Spain, in which COPD and Asthma were not correlated with ICU admission [3]. Furthermore, another cross-sectional analytical study conducted at a tertiary care center in Nepal similarly found that co-morbidities were not associated with the outcome of COVID-19 [18].…”

“…The present study showed that patient presenting with tachypnea during the time of hospital admission were 15.5 times more likely to be admitted in ICU. These findings was alike with several studies where the respiration rate was found to be significantly associated with ICU admission [ 3 , 14 , 17 ].…”

“…The findings was supported by a nested case- control study conducted in China, wherein patient with SpO2 < 95.5% had 2.35 times higher odds of developing severe COVID-19 [ 14 ]. Additionally, a study conducted to identify risk factors for clinical deterioration in patients indicated that reduced oxygen saturation at emergency department was the independent variable associated with clinical deterioration [ 3 ]. A cross sectional comparative study conducted in survivors and non- survivors of Nepal also found that non- survivors tended to exhibit lower oxygen saturation at admission [ 18 ].…”

“…While the majority of patients experience a favorable clinical course, approximately 20% necessitate hospitalization, with a subset progressing rapidly to acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome, or mortality [ 3 ]. Rates for Intensive Care Unit (ICU) admission remain relatively low, with 10–20% of cases requiring intensive care, 3–10% necessitating intubation, and 2–5% resulting in death.…”