Risk factors for severe illness in hospitalized Covid-19 patients at a regional hospital

Turcotte, Justin; Meisenberg, Barry; MacDonald, James; Menon, Nandakumar; Fowler, M. Brook; West, Michaline; Rhule, Jane; Qureshi, Sadaf; MacDonald, Eileen B.

doi:10.1371/journal.pone.0237558

Cited by 38 publications

(40 citation statements)

References 27 publications

(43 reference statements)

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“…Only 6.8% of our patients were admitted to ICU during the study period, which contrasts with 17% admission rates reported in earlier Chinese reports [ 13 ] and 30.8% rates reported at rural hospitals in the USA [ 25 ]. ICU admission rates in other Spanish hospitals were 13% [ 22 ]; however, mortality was high, and similar to the rates which we found in our series (72%).…”

Section: Discussioncontrasting

confidence: 87%

“…In contrast, patients’ sex was not associated significantly to mortality. While male sex has been revealed as a risk factor for mortality in several studies carried out both in Spain [ 22 ] and other countries [ 11 , 14 , 15 , 18 , 23 , 24 ], it was not in many others [ 17 , 20 , 21 , 25 , 26 , 27 ]. Male sex could act, therefore, as a confounding variable for other risk factors more commonly described among males, such as cardiovascular diseases or tobacco use.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Factors at Admission for In-Hospital Mortality from COVID-19 Infection in an Older Rural Population in Central Spain

Maestre-Muñiz

Arias

Arias-González

et al. 2021

JCM

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Background: Risk factors for in-hospital mortality from severe coronavirus disease 2019 (COVID-19) infection have been identified in studies mainly carried out in urban-based teaching hospitals. However, there is little data for rural populations attending community hospitals during the first wave of the pandemic. Methods: A retrospective, single-center cohort study was undertaken among inpatients at a rural community hospital in Spain. Electronic medical records of the 444 patients (56.5% males) admitted due to severe SARS-CoV-2 infection during 26 February 2020–31 May 2020 were reviewed. Results: Mean age was 71.2 ± 14.6 years (rank 22–98), with 69.8% over 65. At least one comorbidity was present in 410 patients (92.3%), with chronic obstructive pulmonary disease (COPD) present in 21.7%. Overall in-hospital mortality was 32%. Multivariate analysis of factors associated with death identified patients’ age (with a cumulative effect per decade), COPD as a comorbidity, and respiratory insufficiency at the point of admission. No additional comorbid conditions proved significant. Among analytical values, increased serum creatinine, LDH > 500 mg/dL, thrombocytopenia (<150 × 109/per L), and lymphopenia (<1000 cells/µL) were all independently associated with mortality during admission. Conclusions: Age remained the major determinant for COVID-19-caused mortality; COPD was the only comorbidity independently associated with in-hospital death, together with respiratory insufficiency and analytical markers at admission.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Prognostic Factors at Admission for In-Hospital Mortality from COVID-19 Infection in an Older Rural Population in Central Spain

Maestre-Muñiz

Arias

Arias-González

et al. 2021

JCM

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“…Most studies were from China 5 , 9 , 11 , 16 – 38 ( n = 26), followed by United States 39 – 43 ( n = 5), Switzerland 44 , 45 ( n = 2), Japan 8 ( n = 1), Korea 46 ( n = 1), Oman 47 ( n = 1), Qatar 48 ( n = 1), Iran 49 ( n = 1), Denmark 50 ( n = 1), Mexico 51 ( n = 1), and Bulgaria 52 ( n = 1). The sample size of included studies ranged from 41 to 5000 patients.…”

Section: Resultsmentioning

confidence: 99%

Comparison of clinical manifestations, pre-existing comorbidities, complications and treatment modalities in severe and non-severe COVID-19 patients: A systemic review and meta-analysis

et al. 2021

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The global pandemic of novel coronavirus disease 2019 (COVID-19) has become an emergency of major international concern. We aim to assess the prevalence of clinical manifestations, pre-existing comorbidities, complications and treatment modalities in COVID-19 patients and compare incidence of these clinical data of severe patients with non-severe patients. An electronic search was performed in four databases to identify studies reporting clinical data of severe and non-severe COVID-19 patients. We calculated the odds ratio (OR) using fixed or random effect model. The analysis included 41 studies with 16,495 patients. The most prevalent clinical manifestations were fever 78.1%, cough 64.6%, fatigue 40.8%, and dyspnea 38.6%. Dyspnea (OR: 4.20, 95% CI: 3.09–5.72), cough (OR: 1.45, 95% CI: 1.18–1.78), and fatigue (OR: 1.40, 95% CI: 1.14–1.72) were found to be statistically significant higher in severe COVID-19 patients. We found that the most prevalent comorbidities were hypertension 32.2%, diabetes 17.1%, and cardiovascular disease 15.3%. Compared with non-severe group, proportion of hypertension (OR: 1.98, 95% CI: 1.62–2.42), diabetes (OR: 2.04, 95% CI: 1.67–2.50), cardiovascular disease (OR: 2.78, 95% CI: 2.00–3.86), and cancer (OR: 1.75, 95% CI: 1.40–2.18) were statistically significant higher in severe group. 24.7% patients presented with ARDS. The pooled effect of ARDS in severe and non-severe cases was 42.69 (OR: 42.69, 95% CI: 21.62–84.31). There was significant higher incidence of antiviral drugs, antibiotics, and glucocorticoids use in severe patients. Compared with non-severe patients, symptoms such as fever, cough, dyspnea, existing comorbidities, and complications are prevalent in severe COVID-19 patients.

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“…Additional predictors of mortality were also investigated with multivariate analysis in this study, and age was confirmed as a key player in COVID-19 patients' outcome. Several explanations can be provided to clarify this finding: (1) older adults are more likely to have multiple comorbidities which represent significant risk factors for COVID-19 complications [31]; (2) frailty, defined as a biological syndrome featured by cumulative declines in different physiological systems and resulting in a loss of reserves and resistance to external stressors, is more common in patients aged over 80 years; (3) immune system efficiency is known to decrease during aging, representing a physiological mechanism leading to a higher susceptibility to infections; 4) reduced mobility and autonomy can lead to a delay in access to hospital care [32][33][34][35][36][37]. Interestingly, we observed distinctive patterns when analyzing the results in terms of the presenting symptoms of SARS-CoV-2 infection.…”

Section: Discussionmentioning

confidence: 99%

The Use of Antiviral Agents against SARS-CoV-2: Ineffective or Time and Age Dependent Result? A Retrospective, Observational Study among COVID-19 Older Adults

Desai

Caltagirone

Sari³

et al. 2021

JCM

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Background: Our aim was to investigate the impact of therapeutics with antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on mortality of older adults affected by coronavirus disease 2019 (COVID-19), taking into consideration the time interval from symptoms onset to drugs administration. Methods: Data from 143 COVID-19 patients over 65 years of age admitted to the Humanitas Clinical and Research Center Emergency Department (Milan, Italy) and treated with Lopinavir/ritonavir (LPV/r) or Darunavir/cobicistat (DVR/c) associated to Hydroxychloroquine (HCQ) were retrospectively analyzed. Statistical analysis was performed by using a logistic regression model and survival analysis to assess the role of different predictors of in-hospital mortality, including an early (<6 days from symptoms onset) vs. late treatment onset, signs and symptoms at COVID-19 presentation, type of antiviral treatment (LPV/r or DVR/c) and patients’ age (65–80 vs. >80 years old). Results: Multivariate analysis showed that an older age (OR: 2.54) and dyspnea as presenting symptom (OR: 2.01) were associated with higher mortality rate, whereas cough as presenting symptom (OR: 0.53) and a timely drug administration (OR: 0.44) were associated with lower mortality. Survival analysis demonstrated that the timing of drug administration had an impact on mortality in 65–80 years-old patients (p = 0.02), whereas no difference was seen in those >80 years-old. This impact was more evident in patients with dyspnea as primary symptom of COVID-19, in whom mortality decreased from 57.1% to 38.3% due to timely drug administration (OR: 0.5; p = 0.04). Conclusions: There was a significant association between the use of a combined antiviral regimen and HCQ and lower mortality, when timely-administered, in COVID-19 patients aged 65–80 years. Our findings support timely treatment onset as a key component in the treatment of COVID-19.

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Risk factors for severe illness in hospitalized Covid-19 patients at a regional hospital

Abstract: Background The Covid-19 pandemic threatens to overwhelm scarce clinical resources. Risk factors for severe illness must be identified to make efficient resource allocations.

Cited by 38 publications

References 27 publications

Prognostic Factors at Admission for In-Hospital Mortality from COVID-19 Infection in an Older Rural Population in Central Spain

Prognostic Factors at Admission for In-Hospital Mortality from COVID-19 Infection in an Older Rural Population in Central Spain

Comparison of clinical manifestations, pre-existing comorbidities, complications and treatment modalities in severe and non-severe COVID-19 patients: A systemic review and meta-analysis

The Use of Antiviral Agents against SARS-CoV-2: Ineffective or Time and Age Dependent Result? A Retrospective, Observational Study among COVID-19 Older Adults

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