clinical course and risk factors for in hospital death in critical covid 19 in wuhan CORD-Papers-2021-10-25 (Version 1)

Title: Clinical Course And Risk Factors For In-hospital Death In Critical COVID-19 In Wuhan, China
Abstract: BACKGROUND The risk factors for mortality of COVID-19 classified as critical type have not been well described. OBJECTIVES This study aimed to described the clinical outcomes and further explored risk factors of in-hospital death for COVID-19 classified as critical type. METHODS This was a single-center retrospective cohort study. From February 5, 2020 to March 4, 2020, 98 consecutive patients classified as critical COVID-19 were included in Huo Shen Shan Hospital. The final date of follow-up was March 29, 2020. The primary outcome was all-cause mortality during hospitalization. Multivariable Cox regression model was used to explore the risk factors associated with in-hospital death. RESULTS Of the 98 patients, 43 (43.9%) died in hospital, 37(37.8%) discharged, and 18(18.4%) remained in hospital. The mean age was 68.5 (63, 75) years, and 57 (58.2%) were female. The most common comorbidity was hypertension (68.4%), followed by diabetes (17.3%), angina pectoris (13.3%). Except the sex (Female: 68.8% vs 49.1%, P=0.039) and angina pectoris (20.9% vs 7.3%, P = 0.048), there was no difference in other demographics and comorbidities between non-survivor and survivor groups. The proportion of elevated alanine aminotransferase, creatinine, D-dimer and cardiac injury marker were 59.4%, 35.7%, 87.5% and 42.9%, respectively, and all showed the significant difference between two groups. The acute cardiac injury, acute kidney injury (AKI), and acute respiratory distress syndrome (ARDS) were observed in 42.9%, 27.8% and 26.5% of the patients. Compared with survivor group, non-survivor group had more acute cardiac injury (79.1% vs 14.5%, P<0.0001), AKI (50.0% vs 10.9%, P<0.0001), and ARDS (37.2% vs 18.2%, P=0.034). Multivariable Cox regression showed increasing hazard ratio of in-hospital death associated with acute cardiac injury (HR, 6.57 [95% CI, 1.89-22.79]) and AKI (HR, 2.60 [95% CI, 1.15-5.86]). CONCLUSIONS COVID-19 classified as critical type had a high prevalence of acute cardiac and kidney injury, which were associated with a higher risk of in-hospital mortality.
Published: 9/28/2020
DOI: 10.1101/2020.09.26.20189522
DOI_URL: http://doi.org/10.1101/2020.09.26.20189522
Author Name: Li, F
Author link: https://covid19-data.nist.gov/pid/rest/local/author/li_f
Author Name: Cai, Y
Author link: https://covid19-data.nist.gov/pid/rest/local/author/cai_y
Author Name: Gao, C
Author link: https://covid19-data.nist.gov/pid/rest/local/author/gao_c
Author Name: Zhou, L
Author link: https://covid19-data.nist.gov/pid/rest/local/author/zhou_l
Author Name: Chen, R
Author link: https://covid19-data.nist.gov/pid/rest/local/author/chen_r
Author Name: Zhang, K
Author link: https://covid19-data.nist.gov/pid/rest/local/author/zhang_k
Author Name: Li, W
Author link: https://covid19-data.nist.gov/pid/rest/local/author/li_w
Author Name: Zhang, R
Author link: https://covid19-data.nist.gov/pid/rest/local/author/zhang_r
Author Name: Zhang, X
Author link: https://covid19-data.nist.gov/pid/rest/local/author/zhang_x
Author Name: Wang, D
Author link: https://covid19-data.nist.gov/pid/rest/local/author/wang_d
Author Name: Liu, Y
Author link: https://covid19-data.nist.gov/pid/rest/local/author/liu_y
Author Name: Tao, L
Author link: https://covid19-data.nist.gov/pid/rest/local/author/tao_l
sha: 506fc9279be89ce3b1ccd931896bef94e7b738d6
license: medrxiv
source_x: MedRxiv; WHO
source_x_url: https://www.who.int/
url: http://medrxiv.org/cgi/content/short/2020.09.26.20189522v1?rss=1 https://doi.org/10.1101/2020.09.26.20189522
has_full_text: TRUE
Keywords Extracted from Text Content: D-dimer creatinine cardiac patients kidney alanine aminotransferase renal inpatients https://doi.org/10.1101/2020.09.26.20189522 doi patients virus particles corticosteroids COVID-19 patients pulmonary hs-TNI ACE2 receptor Wuhan, Kidney Cardiac CK-MB patient participants COVID-19 medRxiv preprint kidney medRxiv ECMO cardiac electrolyte Huoshenshan Huo Shen Shan coronavirus blood CIs
Extracted Text Content in Record: First 5000 Characters:The primary outcome was all-cause mortality during hospitalization. Multivariable Cox regression model was used to explore the risk factors associated with in-hospital death. Of the 98 patients, 43 (43.9%) died in hospital, 37(37.8%) discharged, and 18(18.4%) remained in hospital. The mean age was 68.5 (63, 75) years, and 57 (58.2%) were female. The most common comorbidity was hypertension (68.4%), followed by diabetes (17.3%), angina pectoris (13.3%). Except the sex (Female: 68.8% vs 49.1%, P=0.039) and angina pectoris (20.9% vs 7.3%, P = 0.048), there was no difference in other demographics and comorbidities between non-survivor and survivor groups. The proportion of elevated alanine aminotransferase, creatinine, D-dimer and cardiac injury marker were 59.4%, 35.7%, 87.5% and 42.9%, respectively, and all showed the significant difference between two groups. The acute cardiac injury, acute kidney injury (AKI), and acute respiratory distress syndrome (ARDS) were observed in 42.9%, 27.8% and 26.5% of the patients. Compared with survivor group, non-survivor group had more acute cardiac injury (79.1% vs 14.5%, P<0.0001), AKI (50.0% vs 10.9%, P<0.0001), and ARDS (37.2% vs 18.2%, P=0.034). Multivariable Cox regression showed increasing hazard ratio of in-hospital death associated with acute cardiac injury (HR, 6.57 [95% CI, 1.89-22.79]) and AKI (HR, 2.60 [95% CI, 1.15-5.86]). Beginning in December 2019, the COVID-19 has caused an international outbreak of respiratory illness. By March 30, 2020, the confirmed COVID-19 patients had exceeded 700 thousand. The soaring of COVID-19 has been seen as one of the most serious hazards to global health. COVID-19 is clinically classified as four types: mild, moderate, severe and critical. Critical patients have critical pulmonary injury, systemic inflammatory status and a very high mortality (1) (2) (3) , which leads to tremendous difference in clinical course, medical intervention and prognosis compared with mild to severe type. Illustration of demographics, clinical characteristics, complications and treatment outcome of critical patients is practically important to get further insights into the early origins of adverse outcomes and may ultimately be relevant for developing clinical prediction models. Although some COVID-19 case series and studies have been reported previously (4) (5) (6) , to our knowledge, there are limited studies only including critical patients and specifically focusing on adverse outcomes and the predictive factors. In the present study, we retrospectively included 98 consecutive patients with critical COVID-19 in Huoshenshan hospital (Wuhan, China). We described the patient demographics, laboratory findings, treatment & complications and further explored risk factors of in-hospital death for these patients. This is a single-center, retrospective cohort study. A total of 2074 consecutive patients with COVID-19 were screened in Huo Shen Shan Hospital from February 5, 2020 to March 4, 2020 . Huo Shen Shan Hospital was opened since February 3, 2020, designated by the government only for treating COVID-19. After excluding the mild, . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint The copyright holder for this this version posted September 28, 2020. The demographics, laboratory findings, treatment & complications for participants during hospitalization were collected from electronic medical records by 2 investigators. All data were independently reviewed and entered into the computer database by 2 analysts. . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint The copyright holder for this this version posted September 28, 2020. . https://doi.org/10.1101/2020.09.26.20189522 doi: medRxiv preprint The primary endpoint was all-cause mortality during hospitalization. Other endpoints included: 1) Cardiac injury , defined as blood levels of cardiac injury markers (hs-TNI or CK-MB) above the upper reference limit.; 2)Acute respiratory distress syndrome (ARDS), defined according to the Berlin definition(9); 3)Acute kidney injury, identified according to the Kidney Disease: Improving Global Outcomes definition (KDIGO) (10) . Continuous data are presented as mean SD or median (interquartile range) and compared using the Student's t-test or the Mann-Whitney test depending on their distributions. Categorical variables were expressed as frequencies with percentages and compared with the Chi-square or Fisher exact tests as required. Kaplan-Meier curves were constructed to estimate the cumulative incidence of death and were compared using the log-rank test. Cox proportional hazards models were used to identify risk factors for the occurrence of death. Resul
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