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:

• The average age of the admitted COVID-19 patients was 56 years.
• D-dimer is a commonly available lab test.
  • Remember to obtain this on admission if COVID-19 is suspected.
• The SOFA score can be readily calculated using multiple on-line tools.[2]
• Virus shedding in hospitalized patients continues for a prolonged period.