Division of Infectious Diseases, Department of Internal Medicine, Thomas Mackey Center for Infectious Disease Research, 21928Ascension St. John Hospital, Detroit, MI, USA.
J Intensive Care Med. 2021 Jun;36(6):711-718. doi: 10.1177/08850666211001799. Epub 2021 Mar 24.
Mortality from COVID-19 has been associated with older age, black race, and comorbidities including obesity, Understanding the clinical risk factors and laboratory biomarkers associated with severe and fatal COVID-19 will allow early interventions to help mitigate adverse outcomes. Our study identified risk factors for in-hospital mortality among patients with COVID-19 infection at a tertiary care center, in Detroit, Michigan.
We conducted a single-center, retrospective cohort study at a 776-bed tertiary care urban academic medical center. Adult inpatients with confirmed COVID-19 (nasopharyngeal swab testing positive by real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay) from March 8, 2020, to June 14, 2020, were included. Clinical information including the presence of comorbid conditions (according to the Charlson Weighted Index of Comorbidity (CWIC)), initial vital signs, admission laboratory markers and management data were collected. The primary outcome was in-hospital mortality.
Among 565 hospitalized patients, 172 patients died for a case fatality rate of 30.4%. The mean (SD) age of the cohort was 64.4 (16.2) years, and 294 (52.0%) were male. The patients who died were significantly older (mean [SD] age, 70.4 [14.1] years vs 61.7 [16.1] years; < 0.0001), more likely to have congestive heart failure (35 [20.3%] vs 47 [12.0%]; = 0.009), dementia (47 [27.3%] vs 48 [12.2%]; < 0.0001), hemiplegia (18 [10.5%] vs 18 [4.8%]; = 0.01) and a diagnosis of malignancy (16 [9.3%] vs 18 [4.6%]; = 0.03).From multivariable analysis, factors associated with an increased odds of death were age greater than 60 years (OR = 2.2, = 0.003), CWIC score (OR = 1.1, = 0.023), qSOFA (OR = 1.7, < 0.0001), WBC counts OR = 1.1 = 0.002), lymphocytopenia (OR = 2.0, = 0.003), thrombocytopenia (OR = 1.9, = 0.019), albumin OR = 0.6 = 0.014), and AST levels OR = 2.0, = 0.004) on admission.
This study identified risk factor for in-hospital mortality among patients admitted with COVID-19 in a tertiary care hospital at the onset of U.S. Covid-19 pandemic. After adjusting for age, CWIC score, and laboratory data, qSOFA remained an independent predictor of mortality. Knowing these risk factors may help identify patients who would benefit from close observations and early interventions.
COVID-19 死亡率与年龄较大、黑种人以及肥胖等合并症有关。了解与严重和致命 COVID-19 相关的临床危险因素和实验室生物标志物将有助于早期干预以减轻不良后果。我们的研究在密歇根州底特律的一家 776 张床位的三级护理城市学术医疗中心确定了 COVID-19 感染住院患者的院内死亡率的危险因素。
我们在一家 776 张床位的三级护理城市学术医疗中心进行了单中心回顾性队列研究。纳入 2020 年 3 月 8 日至 2020 年 6 月 14 日鼻咽拭子检测实时逆转录-聚合酶链反应（RT-PCR）检测呈阳性的成年 COVID-19 确诊患者。收集临床信息，包括合并症的存在（根据 Charlson 加权合并症指数（CWIC））、初始生命体征、入院实验室标志物和管理数据。主要结局是院内死亡率。
在 565 名住院患者中，有 172 名患者死亡，病死率为 30.4%。队列的平均（标准差）年龄为 64.4（16.2）岁，294 名（52.0%）为男性。死亡患者年龄明显较大（平均[标准差]年龄，70.4[14.1]岁比 61.7[16.1]岁；<0.0001），更有可能患有充血性心力衰竭（35[20.3%]比 47[12.0%]；=0.009）、痴呆（47[27.3%]比 48[12.2%]；<0.0001）、偏瘫（18[10.5%]比 18[4.8%]；=0.01）和恶性肿瘤诊断（16[9.3%]比 18[4.6%]；=0.03）。多变量分析显示，与死亡几率增加相关的因素包括年龄大于 60 岁（OR=2.2，=0.003）、CWIC 评分（OR=1.1，=0.023）、qSOFA（OR=1.7，<0.0001）、白细胞计数（OR=1.1，=0.002）、淋巴细胞减少症（OR=2.0，=0.003）、血小板减少症（OR=1.9，=0.019）、白蛋白（OR=0.6，=0.014）和 AST 水平（OR=2.0，=0.004）。
本研究确定了美国 COVID-19 大流行期间在三级护理医院因 COVID-19 住院患者的院内死亡率的危险因素。在调整年龄、CWIC 评分和实验室数据后，qSOFA 仍然是死亡率的独立预测因素。了解这些危险因素可能有助于识别需要密切观察和早期干预的患者。
