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24.09.2020 | COVID-19 | IM - ORIGINAL Zur Zeit gratis

Early predictors of in-hospital mortality in patients with COVID-19 in a large American cohort

verfasst von: Amit Bahl, Morgan Nees Van Baalen, Laura Ortiz, Nai-Wei Chen, Courtney Todd, Merit Milad, Alex Yang, Jonathan Tang, Madalyn Nygren, Lihua Qu

Erschienen in: Internal and Emergency Medicine | Ausgabe 8/2020

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Abstract

Coronavirus disease (COVID-19) has aggressively spread across the United States with numerous fatalities. Risk factors for mortality are poorly described. This was a multicentered cohort study identifying patient characteristics and diagnostic markers present on initial evaluation associated with mortality in hospitalized COVID-19 patients. Epidemiological, demographic, clinical, and laboratory characteristics of survivors and non-survivors were obtained from electronic medical records and a multivariable survival regression analysis was conducted to identify risk factors of in-hospital death. Of 1629 consecutive hospitalized adult patients with confirmed COVID-19 from March 1st thru March 31, 2020, 1461 patients were included in final analysis. 327 patients died during hospitalization and 1134 survived to discharge. Median age was 62 years (IQR 50.0, 74.0) with 56% of hospitalized patients under the age of 65. 47% were female and 63% identified as African American. Most patients (55%) had either no or one comorbidity. In multivariable analysis, older age, admission respiratory status including elevated respiratory rate and oxygen saturation ≤ 88%, and initial laboratory derangements of creatinine > 1.33 mg/dL, alanine aminotransferase > 40 U/L, procalcitonin > 0.5 ng/mL, and lactic acid ≥ 2 mmol/L increased risk of in-hospital death. This study is one of the largest analyses in an epicenter for the COVID-19 pandemic. Older age, low oxygen saturation and elevated respiratory rate on admission, and initial lab derangements including renal and hepatic dysfunction and elevated procalcitonin and lactic acid are risk factors for in-hospital death. These factors can help clinicians prognosticate and should be considered in management strategies.
Literatur
1.
Zurück zum Zitat Zhu N, Zhang D, Wang W et al (2020) China Novel Coronavirus investigating and research team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 382:727–733CrossRefPubMedCentral Zhu N, Zhang D, Wang W et al (2020) China Novel Coronavirus investigating and research team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 382:727–733CrossRefPubMedCentral
5.
Zurück zum Zitat Holshue ML, DeBolt C, Lindquist S et al (2020) First case of 2019 novel coronavirus in the United States. N Engl J Med 382:929–936CrossRefPubMedCentral Holshue ML, DeBolt C, Lindquist S et al (2020) First case of 2019 novel coronavirus in the United States. N Engl J Med 382:929–936CrossRefPubMedCentral
7.
Zurück zum Zitat Huang C, Wang Y, Li X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan. China Lancet 395:497–506CrossRef Huang C, Wang Y, Li X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan. China Lancet 395:497–506CrossRef
8.
Zurück zum Zitat Wang D, Hu B, Hu C et al (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan. China JAMA 323(11):1061–1069CrossRef Wang D, Hu B, Hu C et al (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan. China JAMA 323(11):1061–1069CrossRef
9.
Zurück zum Zitat Chen N, Zhou M, Dong X et al (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 395:507–513CrossRefPubMedCentral Chen N, Zhou M, Dong X et al (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 395:507–513CrossRefPubMedCentral
13.
Zurück zum Zitat Chan JF, Yuan S, Kok KH et al (2020) A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 395:514–523CrossRefPubMedCentral Chan JF, Yuan S, Kok KH et al (2020) A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 395:514–523CrossRefPubMedCentral
15.
Zurück zum Zitat Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Prac 120:c179–c184 Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Prac 120:c179–c184
16.
Zurück zum Zitat Thygesen K, Alpert JS, Jaffe AS et al (2012) Third universal definition of myocardial infarction. J Am Coll Cardiol 60:1581–1598CrossRef Thygesen K, Alpert JS, Jaffe AS et al (2012) Third universal definition of myocardial infarction. J Am Coll Cardiol 60:1581–1598CrossRef
17.
18.
Zurück zum Zitat Smina M, Salam A, Khamiees M, Gada P, Amoateng-Adjepong Y, Manthous CA (2003) Cough peak flows and extubation outcomes. Chest 124(1):262–268CrossRefPubMedCentral Smina M, Salam A, Khamiees M, Gada P, Amoateng-Adjepong Y, Manthous CA (2003) Cough peak flows and extubation outcomes. Chest 124(1):262–268CrossRefPubMedCentral
19.
Zurück zum Zitat Zhou F, Ting Y, Du R et al (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395:1054–1062CrossRefPubMedCentral Zhou F, Ting Y, Du R et al (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395:1054–1062CrossRefPubMedCentral
20.
Zurück zum Zitat Chen T, Wu D, Chen H et al (2020) Clinical characteristics of 113 deceased patients with coronavirus disease 2019: a retrospective study. BMJ 368:m1091CrossRefPubMedCentral Chen T, Wu D, Chen H et al (2020) Clinical characteristics of 113 deceased patients with coronavirus disease 2019: a retrospective study. BMJ 368:m1091CrossRefPubMedCentral
21.
Zurück zum Zitat Grasselli G, Zangrillo A, Zanella A et al (2020) COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region. Italy. JAMA. 323(26):1574–1581CrossRef Grasselli G, Zangrillo A, Zanella A et al (2020) COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region. Italy. JAMA. 323(26):1574–1581CrossRef
22.
Zurück zum Zitat Hoffman M, Kleine-Weber H, Schroeder S (2020) SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell 181:271–280CrossRef Hoffman M, Kleine-Weber H, Schroeder S (2020) SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell 181:271–280CrossRef
23.
Zurück zum Zitat Patel SK, Velkoska E, Burrell LM (2013) Emerging markers in cardiovascular disease: where does angiotension-converting enzyme 2 fit in? Clin Exp Pharmacol Physiol 40(8):551–559CrossRef Patel SK, Velkoska E, Burrell LM (2013) Emerging markers in cardiovascular disease: where does angiotension-converting enzyme 2 fit in? Clin Exp Pharmacol Physiol 40(8):551–559CrossRef
24.
Zurück zum Zitat Channappanavar R, Fett C, Mack M, Ten Eyck PP, Meyerholz DK, Perlman S (2017) Sex-based differences in susceptibility to SARS-CoV infection. J Immunol 198(10):4046–4053CrossRefPubMedCentral Channappanavar R, Fett C, Mack M, Ten Eyck PP, Meyerholz DK, Perlman S (2017) Sex-based differences in susceptibility to SARS-CoV infection. J Immunol 198(10):4046–4053CrossRefPubMedCentral
25.
Zurück zum Zitat Team CC-R (2020) Preliminary estimates of the prevalence of selected underlying health conditions among patients with Coronavirus Disease 2019—United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep. 69(13):382–386CrossRef Team CC-R (2020) Preliminary estimates of the prevalence of selected underlying health conditions among patients with Coronavirus Disease 2019—United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep. 69(13):382–386CrossRef
30.
Zurück zum Zitat Cheng Y, Luo R, Wang K et al (2020) Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 97:829–838CrossRefPubMedCentral Cheng Y, Luo R, Wang K et al (2020) Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 97:829–838CrossRefPubMedCentral
35.
Zurück zum Zitat Yu IT, Xie ZH, Tsoi KK et al (2007) Why did outbreaks of severe acute respiratory syndrome occur in some hospital wards but not in others? Clin Infect Dis 44(8):1017–1025CrossRefPubMedCentral Yu IT, Xie ZH, Tsoi KK et al (2007) Why did outbreaks of severe acute respiratory syndrome occur in some hospital wards but not in others? Clin Infect Dis 44(8):1017–1025CrossRefPubMedCentral
Metadaten
Titel
Early predictors of in-hospital mortality in patients with COVID-19 in a large American cohort
verfasst von
Amit Bahl
Morgan Nees Van Baalen
Laura Ortiz
Nai-Wei Chen
Courtney Todd
Merit Milad
Alex Yang
Jonathan Tang
Madalyn Nygren
Lihua Qu
Publikationsdatum
24.09.2020
Verlag
Springer International Publishing
Schlagwort
COVID-19
Erschienen in
Internal and Emergency Medicine / Ausgabe 8/2020
Print ISSN: 1828-0447
Elektronische ISSN: 1970-9366
DOI
https://doi.org/10.1007/s11739-020-02509-7

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