Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan

Xiaochen Li, Shuyun Xu, Muqing Yu, Ke Wang, Yu Tao, Ying Zhou, Jing Shi, Min Zhou, Bo Wu, Zhenyu Yang, Cong Zhang, Junqing Yue, Zhiguo Zhang, Harald Renz, Xiansheng Liu, Jungang Xie, Min Xie, Jianping Zhao, Xiaochen Li, Shuyun Xu, Muqing Yu, Ke Wang, Yu Tao, Ying Zhou, Jing Shi, Min Zhou, Bo Wu, Zhenyu Yang, Cong Zhang, Junqing Yue, Zhiguo Zhang, Harald Renz, Xiansheng Liu, Jungang Xie, Min Xie, Jianping Zhao

Abstract

Background: In December 2019, the coronavirus disease 2019 (COVID-19) outbreak occurred in Wuhan. Data on the clinical characteristics and outcomes of patients with severe COVID-19 are limited.

Objective: We sought to evaluate the severity on admission, complications, treatment, and outcomes of patients with COVID-19.

Methods: Patients with COVID-19 admitted to Tongji Hospital from January 26, 2020, to February 5, 2020, were retrospectively enrolled and followed-up until March 3, 2020. Potential risk factors for severe COVID-19 were analyzed by a multivariable binary logistic model. Cox proportional hazard regression model was used for survival analysis in severe patients.

Results: We identified 269 (49.1%) of 548 patients as severe cases on admission. Older age, underlying hypertension, high cytokine levels (IL-2R, IL-6, IL-10, and TNF-α), and high lactate dehydrogenase level were significantly associated with severe COVID-19 on admission. The prevalence of asthma in patients with COVID-19 was 0.9%, markedly lower than that in the adult population of Wuhan. The estimated mortality was 1.1% in nonsevere patients and 32.5% in severe cases during the average 32 days of follow-up period. Survival analysis revealed that male sex, older age, leukocytosis, high lactate dehydrogenase level, cardiac injury, hyperglycemia, and high-dose corticosteroid use were associated with death in patients with severe COVID-19.

Conclusions: Patients with older age, hypertension, and high lactate dehydrogenase level need careful observation and early intervention to prevent the potential development of severe COVID-19. Severe male patients with heart injury, hyperglycemia, and high-dose corticosteroid use may have a high risk of death.

Keywords: COVID-19; SARS-CoV-2; mortality; risk factors; severity.

Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Figures

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The effect of various potential risk factors on patients with severe COVID-19 at admission.
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