Journal article

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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Author(s): Zhou F, Yu T, Du R, et al

Lancet Published Online March 9, 2020

Respiratory critical care
Respiratory infections
Epidemiology
General respiratory patient care
Public health
Respiratory intensive care

Digest Author(s): Stylianos Loukides, e-Learning Director / 14 March, 2020

Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this retrospective cohort study the authors wanted to determine the risk factors associated with in-hospital death. The study is a retrospective one and involved two cohorts of adult patients all diagnosed with COVID-19 between 29 Dec 2019 and 31 Jan 2020.

Epidemiological, demographic, clinical, laboratory, treatment, and outcome data were extracted from electronic medical records. 191 patients were finally included in the analysis. 137 were defined as survivors while 53 as non survivor ones.

Some important issues: The median time from illness onset to discharge was 22 days, whereas the median time to death was 18,5 days.The predominant co-morbidity was hypertension followed by diabetes and coronary heart disease. All co-morbidities had a higher prevalence in non survivors. Median age was 56 years, 69 for non survivors and 52 for survivors. 32 patients required mechanical ventilation and 31 of them died (97%). The predominant complication was sepsis followed by ARDS, HF and septic shock.

In an univariable analysis, in-hospital death was markedly associated with diabetes, hypertension or coronary heart disease, older age, presence of lymphopenia, leucocytosis, elevated ALT, elevated LDH, high-sensitivity cardiac troponin I, creatine kinase, d-dimer, serum ferritin, IL-6, prothrombin time, creatinine, and procalcitonin.

The Sequential Organ Failure Assessment (SOFA) score was higher in non-survivors with 6.14 OR for in-hospital death. Sustained detection in throat samples was similar in the two groups. Interestingly the initiation of Lopinavir/ritonavir failed to shorten the viral shedding.

Comments

As clinicians we have to early identify the variables that drive mortality. Considering the data of the current study, we have to focus on three important points:

  • the older age
  • the higher SOFA score (actually predicts sepsis, septic shock & multi-organ failure)
  • the increased values of d-dimers (>1μg/ml)

Another important issue is the presence of co-morbidities. Cardiovascular related and diabetes are the predominant ones. Randomized anti-viral strategies need to be addressed. Two of them are currently in progress.