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Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study.
Int J Med Sci. 2020; 17(9):1281-1292.IJ

Abstract

Rationale:

Up to date, the exploration of clinical features in severe COVID-19 patients were mostly from the same center in Wuhan, China. The clinical data in other centers is limited. This study aims to explore the feasible parameters which could be used in clinical practice to predict the prognosis in hospitalized patients with severe coronavirus disease-19 (COVID-19).

Methods:

In this case-control study, patients with severe COVID-19 in this newly established isolation center on admission between 27 January 2020 to 19 March 2020 were divided to discharge group and death event group. Clinical information was collected and analyzed for the following objectives: 1. Comparisons of basic characteristics between two groups; 2. Risk factors for death on admission using logistic regression; 3. Dynamic changes of radiographic and laboratory parameters between two groups in the course.

Results:

124 patients with severe COVID-19 on admission were included and divided into discharge group (n=35) and death event group (n=89). Sex, SpO2, breath rate, diastolic pressure, neutrophil, lymphocyte, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), and D-dimer were significantly correlated with death events identified using bivariate logistic regression. Further multivariate logistic regression demonstrated a significant model fitting with C-index of 0.845 (p<0.001), in which SpO2≤89%, lymphocyte≤0.64×109/L, CRP>77.35mg/L, PCT>0.20μg/L, and LDH>481U/L were the independent risk factors with the ORs of 2.959, 4.015, 2.852, 3.554, and 3.185, respectively (p<0.04). In the course, persistently lower lymphocyte with higher levels of CRP, PCT, IL-6, neutrophil, LDH, D-dimer, cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and increased CD4+/CD8+ T-lymphocyte ratio and were observed in death events group, while these parameters stayed stable or improved in discharge group.

Conclusions:

On admission, the levels of SpO2, lymphocyte, CRP, PCT, and LDH could predict the prognosis of severe COVID-19 patients. Systematic inflammation with induced cardiac dysfunction was likely a primary reason for death events in severe COVID-19 except for acute respiratory distress syndrome.

Authors+Show Affiliations

Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China. Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China. Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China.Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China. Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China. Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China. Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China. Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China. Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China. Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China.Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China. Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32547323

Citation

Pan, Feng, et al. "Factors Associated With Death Outcome in Patients With Severe Coronavirus Disease-19 (COVID-19): a Case-control Study." International Journal of Medical Sciences, vol. 17, no. 9, 2020, pp. 1281-1292.
Pan F, Yang L, Li Y, et al. Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study. Int J Med Sci. 2020;17(9):1281-1292.
Pan, F., Yang, L., Li, Y., Liang, B., Li, L., Ye, T., Li, L., Liu, D., Gui, S., Hu, Y., & Zheng, C. (2020). Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study. International Journal of Medical Sciences, 17(9), 1281-1292. https://doi.org/10.7150/ijms.46614
Pan F, et al. Factors Associated With Death Outcome in Patients With Severe Coronavirus Disease-19 (COVID-19): a Case-control Study. Int J Med Sci. 2020;17(9):1281-1292. PubMed PMID: 32547323.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study. AU - Pan,Feng, AU - Yang,Lian, AU - Li,Yuncheng, AU - Liang,Bo, AU - Li,Lin, AU - Ye,Tianhe, AU - Li,Lingli, AU - Liu,Dehan, AU - Gui,Shan, AU - Hu,Yu, AU - Zheng,Chuansheng, Y1 - 2020/05/18/ PY - 2020/04/09/received PY - 2020/05/05/accepted PY - 2020/6/18/entrez PY - 2020/6/18/pubmed PY - 2020/6/23/medline KW - COVID-19 KW - Critical care KW - Prognosis KW - Radiography KW - Risk factors SP - 1281 EP - 1292 JF - International journal of medical sciences JO - Int J Med Sci VL - 17 IS - 9 N2 - Rationale: Up to date, the exploration of clinical features in severe COVID-19 patients were mostly from the same center in Wuhan, China. The clinical data in other centers is limited. This study aims to explore the feasible parameters which could be used in clinical practice to predict the prognosis in hospitalized patients with severe coronavirus disease-19 (COVID-19). Methods: In this case-control study, patients with severe COVID-19 in this newly established isolation center on admission between 27 January 2020 to 19 March 2020 were divided to discharge group and death event group. Clinical information was collected and analyzed for the following objectives: 1. Comparisons of basic characteristics between two groups; 2. Risk factors for death on admission using logistic regression; 3. Dynamic changes of radiographic and laboratory parameters between two groups in the course. Results: 124 patients with severe COVID-19 on admission were included and divided into discharge group (n=35) and death event group (n=89). Sex, SpO2, breath rate, diastolic pressure, neutrophil, lymphocyte, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), and D-dimer were significantly correlated with death events identified using bivariate logistic regression. Further multivariate logistic regression demonstrated a significant model fitting with C-index of 0.845 (p<0.001), in which SpO2≤89%, lymphocyte≤0.64×109/L, CRP>77.35mg/L, PCT>0.20μg/L, and LDH>481U/L were the independent risk factors with the ORs of 2.959, 4.015, 2.852, 3.554, and 3.185, respectively (p<0.04). In the course, persistently lower lymphocyte with higher levels of CRP, PCT, IL-6, neutrophil, LDH, D-dimer, cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and increased CD4+/CD8+ T-lymphocyte ratio and were observed in death events group, while these parameters stayed stable or improved in discharge group. Conclusions: On admission, the levels of SpO2, lymphocyte, CRP, PCT, and LDH could predict the prognosis of severe COVID-19 patients. Systematic inflammation with induced cardiac dysfunction was likely a primary reason for death events in severe COVID-19 except for acute respiratory distress syndrome. SN - 1449-1907 UR - https://www.unboundmedicine.com/medline/citation/32547323/Factors_associated_with_death_outcome_in_patients_with_severe_coronavirus_disease_19__COVID_19_:_a_case_control_study_ L2 - https://www.medsci.org/v17p1281.htm DB - PRIME DP - Unbound Medicine ER -