Clinical course and risk factors for mortality in COVID-19 patients in Wuhan, China

1. In-hospital COVID-19-related death was associated with older age, d-dimer levels greater than 1.0μg/mL, and higher Sequential Organ Failure Assessment upon assessment.

2. Median viral shedding in survivors was 20 days but was present until death in fatal cases.

3. Hypertension, diabetes, and coronary artery disease were the most common comorbidities in the sample of patients with laboratory-confirmed SARS-CoV-2 infection.

Evidence Rating Level: 2 (Good)

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Beyond clinical and epidemiological studies, few studies have tasked themselves with assessing risk factors, clinical course, or viral shedding. This retrospective cohort study included all adult inpatients (≥18 years) from two hospitals in Wuhan, China who had confirmed COVID-19 and either passed away or were discharged by January 31, 2020. With demographic, laboratory (serial samples for viral RNA detection), clinical, and treatment data from electronic medical records, researchers intended to compare survivors and non-survivors. A total of 191 patients were included in this study (median [IQR] age = 56.0 [46.0 to 67.0] years, 38% female), 71.7% of whom were discharged and the remainder passed away. Along with fever and cough, 40% of patients presented with lymphocytopenia. Roughly 95% were treated with antibiotics and 21% received antivirals. Statistically significant differences between survivors and non-survivors were found in terms of several treatments, with the non-survivors being more likely to receive these treatments: corticosteroids (p = 0.0005), intravenous immunoglobin (p<0.0001), high-flow nasal cannula oxygen therapy (p<0.0001), non-invasive mechanical ventilation (p<0.0001), invasive mechanical ventilation (p<0.0001), renal replacement therapy (p<0.0001), and extracorporeal membrane oxygenation (p = 0.0054). Approximately 48% of the sample possessed a comorbid conditionincluding hypertension (30%), diabetes (19%), coronary heart disease (8%). Analyses suggested increased odds of death associated with older age (OR 1.10, 95% CI 1.03 to 1.17 per year increase, p = 0.0043), d-dimer greater than 1μg/mL (OR 18.42, 95% CI 2.64 to 128.55, p = 0.0033), and higher Sequential Organ Failure Assessment score (OR 5.65, 95% CI 2.61 to 12.23, p<0.0001) at the time of admission. SARS-CoV-2 was detected until death in non-survivors but the median duration for viral shedding in survivors was 20.0 days (IQR 17.0 to 24.0). Regarding outcomes, the non-survivor group experienced sepsis (100%), respiratory failure (98%), acute respiratory distress syndrome (93%), heart failure (52%), septic shock (70%), coagulopathy (50%), acute cardiac injury (59%), acute kidney injury and secondary infection (50%), hypoproteinemia (37%), and acidosis (30%). Most common in survivors were sepsis (42%), respiratory failure (36%), and heart failure (12%), though all of these between-group comparisons were statistically significant. Overall, this study reported meaningful risk factors, clinical course, treatments undergone, and treatment outcomes in both COVID-19 survivors and non-survivors, serving as a meaningful contribution to the literature and frontline clinicians working with these patients.

Click to read the study in Lancet

Image: PD

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