Evaluating the Effects of Clinical Characteristics and Therapeutic Regimens on Mortality in Hospitalized Patients with Severe COVID-19
-
Elahe Karimpour-Razkenari
,
Javad Boskabadi
,
Monireh Ghazaeian
,
Hamidreza Samaee
,
Hanieh Azizi
,
Fatemeh Esfandiari
,
Seyed Abdollah Mousavi
,
Sahar Fallah
,
Sekineh Talebi
Abstract
Background: The coronavirus disease 2019 (COVID-19) is highly contagious and has turned into a global health problem. In this study, we investigated the role of clinical and laboratory characteristics along with administered therapeutic agents in patients with COVID-19, and identified some effective factors on the mortality of these individuals. Methods: In this retrospective study, we evaluated the data from all the hospitalized patients who had been diagnosed with COVID-19 between February 23 and May 23, 2020. The data were obtained from medical records. Additionally, a checklist was used to record demographic, clinical, laboratory, imaging, and treatment data for each patient. Results: Totally, 478 patients were involved in this study, and their median age was 58.5 years. Of these, 53.3% patients were male. The most common pre-existing underlying disease was hypertension (37.9%), and the mortality group had significantly more comorbidities (85.4%). Higher neutrophil lymphocyte ratio (NLR), lymphopenia, and reduced hemoglobin were more frequent in the mortality group (p < 0.001). Similarly, the need to be admitted to the intensive care unit was significantly greater in the mortality group (p<0.001). The most frequently administered therapeutic regimens included hydroxychloroquine and lopinavir/ritonavir, which did not have any correlation with survival outcome. Conclusion: Older age, opioid addiction, cardiovascular disease, kidney disease, baseline NLR and hemoglobin, and ICU admission were independently associated with COVID-19 mortality. On the other hand, hydroxychloroquine and lopinavir/ritonavir indicated no beneficial effects on patients’ outcome.
2.Control CfD, Prevention. Coronavirus disease 2019 (COVID-19): cases in U.S. 2020.: Centers for Disease Control Prevention; 2020 [cited 2021 march].
3.Control CfD, Prevention. Coronavirus disease 2019 (COVID-19): people who are at increased risk for severe illness. 2020.
4.Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and mortality among black patients and white patients with Covid-19. New Engl J Med. 2020; 382:2534-43.
5.Control CfD, Prevention. Health equity considerations and racial and ethnic minority groups. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention. Available from: https://www cdc gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity html. 2020.
6.Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323:1239-42.
7.Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus disease 2019 case surveillance—United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(24):759-765.
8.Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395:507-13.
9.World Health Organization. (2020). Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance, 28 January 2020. World Health Organization. https://apps.who.int/iris/handle/10665/330893
10.Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012; 120:c179-c84.
11.Lescot T, Karvellas C, Beaussier M, Magder S, Riou B. Acquired liver injury in the intensive care unit. Anesthesiology. 2012; 117:898-904.
12.Organization WH. Anaemia - WHO | World Health Organization. 2020.
13.Guan Wj, Ni Zy, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. New Engl J Med. 2020; 382:1708-20.
14.Sobhani S, Aryan R, Kalantari E, Soltani S, Malek N, Pirzadeh P, et al. Association between Clinical Characteristics and Laboratory Findings with Outcome of Hospitalized COVID-19 Patients: A Report from Northeast Iran. I Interdiscip Perspect Infect Dis. 2021;2021:5552138.
15.Adham D, Habibzadeh S, Ghobadi H, Abbasi-Ghahramanloo A, Moradi-Asl E. Epidemiological Characteristics and Mortality Risk Factors among COVID-19 Patients in Ardabil, Northwest of Iran. BMC Emerg Med. 2021 2;21(1):67..
16.Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020; 323:1775-6.
17.Mirjalili H, Dastgheib SA, Shaker SH, et al. Proportion and mortality of Iranian diabetes mellitus, chronic kidney disease, hypertension and cardiovascular disease patients with COVID-19: a meta-analysis. J Diabetes Metab Disord. 2021;20(1):905-917.
18.McMichael TM, Clark S, Pogosjans S, et al. COVID-19 in a long-term care facility—King County, Washington, February 27–March 9, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):339-342.
19. Dubey MJ, Ghosh R, Chatterjee S, Biswas P, Chatterjee S, Dubey S. COVID-19 and addiction. Diabetes Metab Syndr. 2020; 14:817-23.
20. Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020; 108:154262.
21.Rahmani H, Davoudi-Monfared E, Nourian A, et al. Comparing outcomes of hospitalized patients with moderate and severe COVID-19 following treatment with hydroxychloroquine plus atazanavir/ritonavir. DARU. 2020; 28:625.
22.Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020; 77:683-90.
23.Amrein K, Schnedl C, Holl A, et al. Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial. JAMA. 2014; 312:1520-30.
24. Carpagnano GE, Di Lecce V, Quaranta VN, et al. Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19. J Endocrinol Invest. 2021; 44:765-71.
25.Estebanez M, Ramirez-Olivencia G, Mata T, et al. Clinical evaluation of IFN beta1b in COVID-19 pneumonia: a retrospective study. MedRxiv. 2020.
26.Terpos E, Ntanasis‐Stathopoulos I, Elalamy I, et al. Hematological findings and complications of COVID‐19. Am J Hematol. 2020; 95:834.
27. Rouhani N, Karimpour-razkenari E, Forutan MA, Ghazaeian M, Salehifar E, Rezai MS, Fallah S. Efficacy and Safety of Interferon Beta-1b in the Management of Patients with COVID-19: A Prospective, Open-Label, Non-Randomized Trial. J Pharm Care. 2021;9(3):129-36.
28.Anai M, Akaike K, Iwagoe H, et al. Decrease in hemoglobin level predicts increased risk for severe respiratory failure in COVID-19 patients with pneumonia. Respir Investig. 2021; 59:187-93.
29.Taneri PE, Gómez-Ochoa SA, Llanaj E, et al. Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis. Europ J Epidemiol. 2020; 35:763-73.
30.Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis. 2020; 14:1753466620937175.
31.Mardani R, Vasmehjani AA, Zali F, et al. Laboratory parameters in detection of COVID-19 patients with positive RT-PCR; a diagnostic accuracy study. Arch Acad Emerg Med. 2020;8(1):e43.
| Files | ||
| Issue | Vol 10, No 3 (Summer 2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jpc.v10i3.10790 | |
| Keywords | ||
| COVID-19 Mortality Epidemiology | ||
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