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Int J Med Sci 2020; 17(9):1281-1292. doi:10.7150/ijms.46614 This issue Cite

Research Paper

Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study

Feng Pan^*1,2, Lian Yang^*1,2, Yuncheng Li^*3, Bo Liang^1,2, Lin Li^1,2, Tianhe Ye^1,2, Lingli Li^1,2, Dehan Liu^1,2, Shan Gui^1,2, Yu Hu⁴, Chuansheng Zheng^1,2✉

1. Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.
2. Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
3. Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China.
4. Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China.
*These three authors contributed equally to this manuscript.

✉ Corresponding author: Chuansheng Zheng, Prof, MD, PhD, Chief in Department of Radiology. Email: hqzcsxhcom; Phone: +86 027 85353238. 1Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 2Hubei Province Key Laboratory of Molecular Imaging, No. 1277 Jiefang Avenue, Wuhan, China. Yu Hu, Prof, MD, PhD. Email: dr_huyucom; Phone: +86 27 85726387; Fax: +86 27 85726387. 4Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, China More

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.

Keywords: COVID-19, Critical care, Prognosis, Risk factors, Radiography

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