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. 2020 Jul;146(1):110-118.
doi: 10.1016/j.jaci.2020.04.006. Epub 2020 Apr 12.

Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan

Xiaochen Li  1 , Shuyun Xu  1 , Muqing Yu  1 , Ke Wang  1 , Yu Tao  1 , Ying Zhou  1 , Jing Shi  1 , Min Zhou  1 , Bo Wu  2 , Zhenyu Yang  1 , Cong Zhang  1 , Junqing Yue  1 , Zhiguo Zhang  3 , Harald Renz  4 , Xiansheng Liu  1 , Jungang Xie  1 , Min Xie  5 , Jianping Zhao  6
Affiliations

Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan

Xiaochen Li et al. J Allergy Clin Immunol. 2020 Jul.

Abstract

Background: In December 2019, the coronavirus disease 2019 (COVID-19) outbreak occurred in Wuhan. Data on the clinical characteristics and outcomes of patients with severe COVID-19 are limited.

Objective: We sought to evaluate the severity on admission, complications, treatment, and outcomes of patients with COVID-19.

Methods: Patients with COVID-19 admitted to Tongji Hospital from January 26, 2020, to February 5, 2020, were retrospectively enrolled and followed-up until March 3, 2020. Potential risk factors for severe COVID-19 were analyzed by a multivariable binary logistic model. Cox proportional hazard regression model was used for survival analysis in severe patients.

Results: We identified 269 (49.1%) of 548 patients as severe cases on admission. Older age, underlying hypertension, high cytokine levels (IL-2R, IL-6, IL-10, and TNF-α), and high lactate dehydrogenase level were significantly associated with severe COVID-19 on admission. The prevalence of asthma in patients with COVID-19 was 0.9%, markedly lower than that in the adult population of Wuhan. The estimated mortality was 1.1% in nonsevere patients and 32.5% in severe cases during the average 32 days of follow-up period. Survival analysis revealed that male sex, older age, leukocytosis, high lactate dehydrogenase level, cardiac injury, hyperglycemia, and high-dose corticosteroid use were associated with death in patients with severe COVID-19.

Conclusions: Patients with older age, hypertension, and high lactate dehydrogenase level need careful observation and early intervention to prevent the potential development of severe COVID-19. Severe male patients with heart injury, hyperglycemia, and high-dose corticosteroid use may have a high risk of death.

Keywords: COVID-19; SARS-CoV-2; mortality; risk factors; severity.

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Figures

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The effect of various potential risk factors on patients with severe COVID-19 at admission.
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See this image and copyright information in PMC

Comment in

  • Low prevalence of bronchial asthma and chronic obstructive lung disease among intensive care unit patients with COVID-19.
    Avdeev S, Moiseev S, Brovko M, Yavorovskiy A, Umbetova K, Akulkina L, Tsareva N, Merzhoeva Z, Gainitdinova V, Fomin V. Avdeev S, et al. Allergy. 2020 Oct;75(10):2703-2704. doi: 10.1111/all.14420. Epub 2020 Jun 12. Allergy. 2020. PMID: 32455491 Free PMC article. No abstract available.
  • Prevalence of comorbid asthma in COVID-19 patients.
    Butler MW, O'Reilly A, Dunican EM, Mallon P, Feeney ER, Keane MP, McCarthy C. Butler MW, et al. J Allergy Clin Immunol. 2020 Aug;146(2):334-335. doi: 10.1016/j.jaci.2020.04.061. Epub 2020 Jun 10. J Allergy Clin Immunol. 2020. PMID: 32553599 Free PMC article. No abstract available.
  • Asthmatic patients in COVID-19 outbreak: Few cases despite many cases.
    Caminati M, Lombardi C, Micheletto C, Roca E, Bigni B, Furci F, Girelli D, Senna G, Crisafulli E. Caminati M, et al. J Allergy Clin Immunol. 2020 Sep;146(3):541-542. doi: 10.1016/j.jaci.2020.05.049. Epub 2020 Jun 22. J Allergy Clin Immunol. 2020. PMID: 32620309 Free PMC article. No abstract available.
  • Reply.
    Yue J, Qin L, Zhang C, Xie M. Yue J, et al. J Allergy Clin Immunol. 2020 Sep;146(3):542. doi: 10.1016/j.jaci.2020.06.002. Epub 2020 Jun 22. J Allergy Clin Immunol. 2020. PMID: 32620310 Free PMC article. No abstract available.

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