Risk factors for in-hospital mortality in patients with COVID-19

Abstract

Objective — to determine the association of basic demographic, clinical, and routine laboratory characteristics with the risk of adverse outcomes in patients with COVID-19. Materials and methods. Data of 320 patients hospitalized in the City Clinical Hospital No. 21 named after Prof. Ye. G. Popkova with a diagnosis of coronavirus disease19 (SARS-CoV2+ RNA)) were studied. Women — 156 (48.8 %), men — 164 (51.2 %), the mean age of the patients — (60.3 ± 13.6) years. Patients were divided into 2 groups: Group I — 270 (84.4 %) people who were discharged from the hospital with recovery or significant improvement in their condition, Group II — 50 (15.6 %) patients who died as a result of the disease (p = 0.010). The average period from the onset of the disease to hospitalization was 9 (7; 11) days. Statistical processing of the research results was carried out using the Statistica v. 6.1 software package. Results and discussion. Most of the deceased patients were older than 60 years — 36 (72.0 %) (p < 0.001). The maximum number of fatalities is in the age range of 60—69 years. Mortality among men was 1.5 times higher than among women — 30 (60.0 %) vs 20 (40.0 %) (p = 0.046). In the II group, the following were observed significantly more often: ischemic heart disease and hypertension — respectively 54.0 vs 20.7 % (p < 0.001) and 70.0 vs 50.0 % (p = 0.009); other heart diseases (OR — 7.23, rv = 0.202, p < 0.001), obesity (OR — 2.97, rv = 0.186, p < 0.001), diabetes (OR — 2.38, rv = 0.146; p = 0.009).The risk of mortality increased in the presence of cough (OR — 11.87, p = 0.012), fever (OR — 3.44, p < 0.001); lymphopenia (OR — 3.82, p < 0.001); hyperglycemia (OR — 4.69, p < 0.001); increased C-reactive protein (CRP) (OR — 5.96, p < 0.001), especially above 100 mg/l (OR from 39.86 to 52.35 at p < 0.01 and p < 0.001). However, thrombocytosis and lymphomonocytosis were more often observed during the benign course of the disease (respectively: p < 0.001, p = 0.051). A direct relationship between the probability of mortality and age (rs = 0.143, p = 0.011), respiratory rate (rs = 0.332, p < 0.001) and heart rate (rs = 0.159, p = 0.004) was revealed; fever (rs = 0.152, p = 0.006), quantitative indicators: segmented neutrophils (rs = 0.275, p < 0.001), urea (rs = 0.309, p < 0.001), urea nitrogen (rs = 0.300, p < 0.001), residual nitrogen (rs = 0.288, p < 0.001), creatinine (rs = 0.111, p = 0.047), glucose (rs = 0.273, p < 0.001), CRP (rs = 0.348, p < 0.001), prothrombin time (rs = 0.149, p = 0.008), international normalized ratio (rs = 0.193, p = 0.001). A inverse relationship was determined with blood oxygen saturation (rs = – 0.431, p < 0.001); levels of lymphocytes, bands, platelets and prothrombin index (respectively: rs = – 0.278, p < 0.001; rs = – 0.118, p = 0.034; rs = – 0.223, p < 0.001; rs = – 0.170, p = 0.002). Conclusions. The following are associated with in-hospital mortality in patients with COVID-19: older age, coronary heart disease, stage III hypertension, diabetes, stage III obesity, clinical and laboratory signs: fever, shortness of breath, cough, lymphopenia, CRP content in the blood more than 100 mg/l, hyperglycemia, increased markers of kidney damage and hypercoagulation. The obtained results may be useful for predicting the course of the coronavirus disease.