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Risk factors for severe illness in hospitalized Covid-19 patients at a regional hospital.

ABSTRACT: BACKGROUND:The Covid-19 pandemic threatens to overwhelm scarce clinical resources. Risk factors for severe illness must be identified to make efficient resource allocations. OBJECTIVE:To evaluate risk factors for severe illness. DESIGN:Retrospective, observational case series. SETTING:Single-institution. PARTICIPANTS:First 117 consecutive patients hospitalized for Covid-19 from March 1 to April 12, 2020. EXPOSURE:None. MAIN OUTCOMES AND MEASURES:Intensive care unit admission or death. RESULTS:In-hospital mortality was 24.8% and average total length of stay was 11.82 days (95% CI: 10.01 to 13.63 days). 30.8% of patients required intensive care unit admission and 29.1% required mechanical ventilation. Multivariate regression identified the amount of supplemental oxygen required at admission (OR: 1.208, 95% CI: 1.011-1.443, p = .037), sputum production (OR: 6.734, 95% CI: 1.630-27.812, p = .008), insulin dependent diabetes mellitus (OR: 11.873, 95% CI: 2.218-63.555, p = .004) and chronic kidney disease (OR: 4.793, 95% CI: 1.528-15.037, p = .007) as significant risk factors for intensive care unit admission or death. Of the 48 patients who were admitted to the intensive care unit or died, this occurred within 3 days of arrival in 42%, within 6 days in 71%, and within 9 days in 88% of patients. CONCLUSIONS:At our regional medical center, patients with Covid-19 had an average length of stay just under 12 days, required ICU care in 31% of cases, and had a 25% mortality rate. Patients with increased sputum production and higher supplemental oxygen requirements at admission, and insulin dependent diabetes or chronic kidney disease may be at increased risk for severe illness. A model for predicting intensive care unit admission or death with excellent discrimination was created that may aid in treatment decisions and resource allocation. Early identification of patients at increased risk for severe illness may lead to improved outcomes in patients hospitalized with Covid-19.

SUBMITTER: Turcotte JJ

PROVIDER: S-EPMC7423129 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Risk factors for severe illness in hospitalized Covid-19 patients at a regional hospital.

Turcotte Justin J JJ Meisenberg Barry R BR MacDonald James H JH Menon Nandakumar N Fowler Marcia B MB West Michaline M Rhule Jane J Qureshi Sadaf S SS MacDonald Eileen B EB

PloS one 20200812 8

<h4>Background</h4>The Covid-19 pandemic threatens to overwhelm scarce clinical resources. Risk factors for severe illness must be identified to make efficient resource allocations.<h4>Objective</h4>To evaluate risk factors for severe illness.<h4>Design</h4>Retrospective, observational case series.<h4>Setting</h4>Single-institution.<h4>Participants</h4>First 117 consecutive patients hospitalized for Covid-19 from March 1 to April 12, 2020.<h4>Exposure</h4>None.<h4>Main outcomes and measures</h4> ...[more]

PMID: 32785285

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Project description:ObjectivesTo determine the risk factors for in-hospital mortality in patients with COVID-19 from a Peruvian national hospital.MethodsRetrospective cohort study of medical records of patients with COVID-19 hospitalized at Hospital Nacional Hipólito Unanue (HNHU) during the months of April to August 2020. The dependent variable was in-hospital mortality. Independent variables included sociodemographic and clinical characteristics, physical examination findings, oxygen saturation (SaO2) at admission, treatment received during hospitalization and laboratory results at admission. A Cox regression model was used to evaluate the crude and adjusted hazard ratios for associated factors.ResultsWe included 1418 patients. Median age was 58 years (IQR 47-68 years) and 944 (66.6%) were male. The median length of hospitalization was 7 (4-13) days, and the mortality rate was 46%. The most frequent comorbidities were type 2 diabetes mellitus, hypertension, and obesity. In the adjusted analysis, mortality was associated with age (HR 1.02; 95%CI 1.02-1.03), history of surgery (HR 1.89; 95%CI 1.31-2.74), lower oxygen saturation at admission (HR 4.08; CI95% 2.72-8.05 for SaO2<70% compared to SaO2>94%), the presence of poor general condition (HR 1.81; 95% CI 1.29-2.53), altered state of consciousness (HR 1.58; 95%CI 1.18-2.11) and leukocyte levels (HR 1.01; 95%CI 1.00-1. 02). Treatment with ivermectin (HR 1.44; 95%CI 1.18-1.76) and azithromycin (HR 1.25; 95%CI 1.03-1.52) were associated with higher mortality. Treatment with corticosteroids at low to moderate doses was associated with lower mortality (HR 0.56 95%CI 0. 37-0. 86) in comparison to no steroid use.ConclusionA high mortality was found in our cohort. Low oxygen saturation at admission, age, and the presence of hematological and biochemical alterations were associated with higher mortality. The use of hydroxychloroquine, ivermectin or azithromycin was not useful and was probably associated with unfavorable outcomes. The use of corticosteroids at moderate doses was associated with lower mortality.

Dataset Information

Risk factors for severe illness in hospitalized Covid-19 patients at a regional hospital.

Publications

Risk factors for severe illness in hospitalized Covid-19 patients at a regional hospital.

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