Welcome to PracticeUpdate! We hope you are enjoying temporary access to this content.
Please register today for a free account and gain full access
to all of our expert-selected content.
Already Have An Account? Log in Now
Clinical Course and Risk Factors for Mortality of Adult Inpatients With COVID-19 in Wuhan, China
TAKE-HOME MESSAGE
-
A study of 191 patients hospitalized with confirmed COVID-19 in Wuhan, China, demonstrated an increased mortality risk associated with older age, higher Sequential Organ Failure Assessment score, and elevated D-dimer. Researchers also found a median viral shedding period of 20 days.
- Figure 1 in the article is a very good display of symptom onset in the disease course based on survivors and non-survivors. Of note, both groups had a period of 6 days with only cough and fever preceding any shortness of breath.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
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). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described.
METHODS
In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.
FINDINGS
191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 μg/L (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days.
INTERPRETATION
The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/L could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
Additional Info
Disclosure statements are available on the authors' profiles:
Clinical Course and Risk Factors for Mortality of Adult Inpatients With COVID-19 in Wuhan, China: A Retrospective Cohort Study
Lancet 2020 Mar 11;[EPub Ahead of Print], F Zhou, T Yu, R Du, G Fan, Y Liu, Z Liu, J Xiang, Y Wang, B Song, X Gu, L Guan, Y Wei, H Li, X Wu, J Xu, S Tu, Y Zhang, H Chen, B CaoFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Risk Factors for COVID-19 Death
First a quick word about nomenclature so that we are all on the same page: the novel coronavirus causing coronavirus disease-19 (COVID-19) has now been named “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2).
The pandemic of SARS-CoV-2 is accelerating with rapidly increasing numbers. In the United States alone, we now have recorded over 10,000 cases and 150 deaths. It is sobering. We are now able to look into the recent past for some guidance in care management and assessment. Using a retrospective cases series of patients from two hospitals in Wuhan, China, Zhou and colleagues evaluated risk factors for death from COVID-19.[1] They included 191 hospitalized patients in this analysis who had either recovered and were discharged (72%) or had died (28%). Of these, 62% were male and about half had comorbidities (30% with hypertension, 19% with diabetes, and 8% with coronary heart disease). Only 6% were current smokers.
In a multivariate assessment, three factors emerged as predictors of death: higher age [aOR: 1.10 per year (95% CI: 1.07—1.17) P=0.0043], higher SOFA (Sequential Organ Failure Assessment) score [aOR: 5.65 (2.61—12.23) P<0.0001], and D-dimer level > 1 µg/L [aOR: 18.42 (2.64—128.55) P=0.0033] on admission. Other significant findings included an average time from illness onset to hospital discharge of 22 days and 18.5 days for death. Of concern was the long average period of virus shedding of 20 days (range = 8 to 37 days) found in these patients.
Some thoughts for primary care physicians:
References