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Short Term Outcomes and Risk Factors for Mortality in Patients with COVID-19 in Wuhan, China: A Retrospective Study
37 Pages Posted: 23 Mar 2020
More...Abstract
Background: A massive outbreak of Coronavirus disease 2019 (COVID-19) hit Wuhan City, Hubei Province, China and has become a public health emergency of global concern. In this study, we aimed to describe the clinical characteristics and short-term outcomes and explored the mortality-related risk factors.
Methods: In this retrospective, single-centre, case-control study, we examined 315 consecutive patients hospitalized in Wuhan Union Hospital West Area from January 12, 2020 to February 3, 2020, for suspected or confirmed COVID-19. Patients’ data were collected by reviewing the medical records and their 28-day outcomes were followed up. Epidemiological, demographic, clinical and laboratory data were collected and analyzed to look into the differences between survivors and non-survivors and to identify the independent predictors of mortality. Finally, a nomogram scoring system was built for prognostic evaluation.
Findings: Of the 315 patients, 137 were mild and 178 were severely ill cases. As of March 2, 2020, 47 patients deceased, 200 patients were discharged from hospital and 68 patients were still hospitalized. Compared with survivors, non-survivors were older (66 years [IQR, 61-72] vs 56 years [IQR, 41-65], p = 0·001). Univariate analyses showed that a total of 21 laboratory factors differed significantly between survivors and non-survivors. CT scan revealed reticular patterns significantly more frequently observed in the non-survivors (P <0·001). Multivariate analysis exhibited that age above 57 (Hazard Ratio [HR] 2·9, 95% CI 1·03 to 8·22; p=0·045), neutrophil-to-lymphocyte ratio (NLR) higher than 8·0 (HR 4·56, 95% CI 2·25 to 9·23; p<0·0001), and lactate dehydrogenase (LDH) level over 380U/L (HR 7·68, 95% CI 2·23 to 26·44; p=0·001) were independently associated with 28-day mortality. Based on the predicting factors including age, NLR, and LDH, a nomogram scoring system for predicting the 14-day and 28-day survival probability of patients with COVID-19 was developed.
Interpretation: Our results suggest that prognosis is unfavorable for severely ill patients with COVID-19. Age, NLR, and LDH are independent predictors of 28-day mortality.
Funding Statement: This paper was supported by the State Project for Essential Drug Research and Development, China (no. 2019ZX09301001) and the National Natural Science Foundation of China (no. 81770096 and no. 81700091).
Declaration of Interests: The authors declare no competing interests.
Ethics Approval Statement: This study was approved by the ethics committee of Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Keywords: COVID-19, Survivor, Non-survivor, Independent predictor of mortality, nomagram
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