Risk factors for mortality of adult patients with COVID-19 hospitalised in an emerging country: a cohort study

Abstract

ObjectiveTo describe mortality of in-hospital patients with COVID-19 and compare risk factors between survivors and non-survivors.DesignProspective cohort of adult inpatients.SettingTertiary healthcare teaching hospital in Guadalajara, Mexico.ParticipantsAll patients with confirmed COVID-19 hospitalised from 25 March to 7 September 2020 were included. End of study: 7 November 2020.Primary outcome measuresPatient survival analysed by the Kaplan-Meier method and comparison of factors by the log-rank test. Mortality risk factors analysed by multivariate Cox’s proportional-hazard model.ResultsOne thousand ten patients included: 386 (38%) died, 618 (61%) alive at discharge and six (0.6%) remained hospitalised. There was predominance of men (63%) and high frequency of overweight–obesity (71%); hypertension (54%); diabetes (40%); and lung (9%), cardiovascular (8%) and kidney diseases (11%); all of them significantly more frequent in non-survivors. Overweight–obesity was not different between groups, but severity of disease (Manchester Triage System and quick Sequential Organ Failure Assessment) was significantly worse in non-survivors, who were also significantly older (65 vs 45 years, respectively) and had haematological, biochemical, coagulation and inflammatory biomarkers more altered than survivors. Mortality predictors were invasive mechanical ventilation (IMV; OR 3.31, p<0.0001), admission to intensive care unit (ICU; OR 2.18, p<0.0001), age (OR 1.02, p<0.0001), Manchester Triage System (urgent OR 1.44, p=0.02; immediate/very urgent OR 2.02, p=0.004), baseline C reactive protein (CRP; OR 1.002, p=0.009) and antecedent of kidney disease (OR 1.58, p=0.04)ConclusionsMortality in hospitalised patients with COVID-19 in this emerging country centre seemed to be higher than in developed countries. Patients displayed a high frequency of risk factors for poor outcome, but the need for IMV, ICU admission, older age, more severe disease at admission, antecedent of kidney disease and higher CRP levels significantly predicted mortality.

Changes in laboratory value improvement and mortality rates over the course of the pandemic: an international retrospective cohort study of hospitalised patients infected with SARS-CoV-2

“…Our study suggests that older age, male sex, higher CCI, low albumin and lymphocyte count values, and higher CRP, total bilirubin, leucocyte count, neutrophil count, D-dimer, ALT, and AST/ALT were significantly associated with higher mortality risk. While male sex, older age and existing comorbidities are established major risk factors for COVID-19-related mortality, our observations of the associations between higher AST/ALT, ALT and bilirubin with mortality51 52 62 63 are unique. While derangements in liver function tests are well described in prior studies of patients with COVID-19, the patterns of liver dysfunction associated with worse outcomes have been inconsistent 53 64.…”

“…For example, hospitals may have benefited from improved resource allocation strategies and management in smaller surges in hospitalisations 49. Negative trial data for hydroxychloroquine, azithromycin and other pharmacological agents may have led to reduced usage of these drugs and reduced drug-related adverse effects over the course of the pandemic 41 50–53. Further investigations into the potential explanations are warranted as this study was not designed to infer the specific reasons for this improvement.…”

Cellular and Humoral Responses Follow-up for 8 Months after Vaccination with mRNA-Based Anti-SARS-CoV-2 Vaccines

“…Age has already been described as a potential risk factor in COVID-19 severity [ 46 , 47 , 48 ]. Moreover, it has already been seen that vaccinated older adults present lower levels of antibodies in comparison with younger adults [ 21 ], and consequently, they present lower vaccine effectiveness and a higher risk of infection or re-infection [ 49 , 50 , 51 ].…”

Sunlight Exposure and Phototherapy: Perspectives for Healthy Aging in an Era of COVID-19

“…There are many risk factors associated with the severity and mortality of COVID-19, including aging, overweight-obesity, hypertension, diabetes, and lung, cardiovascular, and kidney diseases [43]. In addition, many studies have observed an association between vitamin D 3 insufficiency/deficiency and COVID-19, suggesting the therapeutic potential of vitamin D 3 supplementation for the prevention and treatment of SARS-CoV-2 infection [44][45][46][47][48].…”