Evaluation of Risk Factors for Predicting Mortality in Critically Ill Adult COVID-19 Patients: A Retrospective Cohort Study

Geetanjali T Chilkoti; Vibhor  Gupta; Sapna Jain; Medha Mohta; Rajeev Malhotra; Ashok Kumar Saxena; Sanjana A Tiwari; Chhavi S Sharma

Geetanjali T Chilkoti Professor, Department of Anaesthesia, UCMS & GTB Hospital, Delhi, India.
Vibhor Gupta Assistant Professor, Department of Anaesthesia, UCMS & GTB Hospital, Delhi, India. https://orcid.org/0000-0002-1686-1353
Sapna Jain Post Graduate, Department of Anaesthesia, UCMS & GTB Hospital, Delhi, India.
Medha Mohta Director Professor, Department of Anaesthesia, UCMS & GTB Hospital, Delhi, India.
Rajeev Malhotra Senior Research Scientist, Department of Statistics, Dr. BRA Irch, AIIMS, Delhi, India.
Ashok Kumar Saxena MD, Head of Department & Professor, Department of Anaesthesia, UCMS & GTB Hospital, Delhi, India.
Sanjana A Tiwari Post Graduate, Department of Anaesthesia, UCMS & GTB Hospital, Delhi, India.
Chhavi S Sharma MD, Senior Specialist, Department of Anaesthesia, UCMS & GTB Hospital, Delhi, India.

Keywords: COVID-19, Comorbidity, Mortality, Risk Factors, Outcomes

Abstract

Background and Objective: Various risk factors have been evaluated to predict the mortality associated with COVID-19. We aim to explore and compare the clinical and laboratory risk factors with various outcomes of the disease between survivors and non-survivors amongst patients with moderate to severe COVID-19 disease.
Methods: All COVID-19 adult (â‰¥ 18 years old) ICU in-patients with a definite outcome i.e. either death or discharge were included. The demographic, clinical, laboratory, treatment, and outcome data were retrieved. To explore the association between factors, univariate and multivariate logistic regression were done.
Results: A total of 163 patients were included out of which eight patients were shifted to other hospitals. Finally, a total of 145 patients were included in the study. Out of 145, 47 patients didnâ€™t survive and 98 survived. A significant proportion (85%) of non-survivors were current smokers and were observed to have COPD, HT, and CAD as comorbidities when compared to the survivors. The qSOFA score, CRP, and TLC counts were included in the multivariable logistic regression with the former being the independent risk factor.
Interpretation and Conclusion: Our study highlighted that older age, higher SOFA score, increased levels of total leucocyte count, and C-Reactive protein were independent risk factors affecting the clinical outcome in moderate to severe COVID-19 patients; however, qSOFA was found to be an independent risk factor predictor.

How to cite this article: Chilkoti GT, Gupta V, Jain S, Mohta M, Malhotra R, Saxena AK, Tiwari SA, Sharma CS. Evaluation of Risk Factors for Predicting Mortality in Critically Ill Adult COVID-19 Patients: A Retrospective Cohort Study. J Adv Res Med. 2021;8(3):1-7.

DOI: https://doi.org/10.24321/2349.7181.202110

References

Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, Ren R, Leung KS, Lau EH, Wong JY, Xing X, Xiang N, Wu Y, Li C, ChenQ, Li D, Liu T, Zhao J, Liu M, Tu W, Chen C, Jin L, Yang R, Wang Q, Zhou S, Wang R, Liu H, Luo Y, Liu Y, Shao G, Li H, Tao Z, Yang Y, Deng Z, Liu B, Ma Z, Zhang Y, Shi G, Lam TT, Wu JT, Gao GF, Cowling BJ, Yang B, Leung GM, Feng Z. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382:1199-207. [PubMed] [Google Scholar]

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W; China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727-33. [PubMed] [Google Scholar]

Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, Wang W, Song H, Huang B, Zhu N, Bi Y, Ma X, Zhan F, Wang L, Hu T, Zhou H, Hu Z, Zhou W, Zhao L, Chen J, Meng Y, Wang J, Lin Y, Yuan J, Xie Z, Ma J, Liu WJ, Wang D, Xu W, Holmes EC, Gao GF, Wu G, Chen W, Shi W, Tan W. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395:556-74. [PubMed] [Google Scholar]

Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, Guo GY, Du J, Zheng CL, Zhu Q, Hu M, Li XY, Peng P, Shi HZ. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020;55(5):2000524. [PubMed] [Google Scholar]

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506. [PubMed] [Google Scholar]

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. [PubMed] [Google Scholar]

Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB, Zhang HY, Sun W, Wang Y. COVID-19 patientsâ€™ clinical characteristics, discharge rate, and fatality rate of metaanalysis. J Med Virol. 2020;92(6):577-83. [PubMed] [Google Scholar]

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. [PubMed] [Google Scholar]

Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, Napolitano LM, Oâ€™Grady NP, Bartlett JG, CarratalÃ J, El Solh AA, Ewig S, Fey PD, File Jr TM, Restrepo MI, Roberts JA, Waterer GW, Cruse P, Knight SL, Brozek JL. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63:e61-111. [PubMed] [Google Scholar]

Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120:c179-84. [PubMed] [Google Scholar]

ARDS Definition Task Force; Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307:2526-33. [PubMed] [Google Scholar]

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507-13. [PubMed] [Google Scholar]

Kayina CA, Haritha D, Soni L, Behera S, Nair PR, Gouri M, Girish K, Deeparaj L, Maitra S, Anand RK, Ray BR, Baidya DK, Subramaniam R. Epidemiological & clinical characteristics & early outcome of COVID-19 patients in a tertiary care teaching hospital in India: A preliminary analysis. Indian J Med Res. 2020;152(1):100-4. [PubMed] [Google Scholar]

Mohan A, Tiwari P, Bhatnagar S, Patel A, Maurya A, Dar L, Pahuja S, Garg R, Gupta N, Sahoo B, Gupta R, Meena VP, Vig S, Pandit A, Mittal S, Madan K, Hadda V, Dwivedi T, Choudhary A, Brijwal M, Soneja M, Guleria R, Ratre B, Kumar B, Bhopale S, Panda S, Singh AR, Singh S, Wundavalli L. Clinico-demographic profile & hospital outcomes of COVID-19 patients admitted at a tertiary care centre in north India. Indian J Med Res. 2020;152:61-9. [PubMed] [Google Scholar]

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DS, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708-20. [PubMed] [Google Scholar]

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, Cereda D, Coluccello A, Foti G, Fumagalli R, Iotti G, Latronico N, Lorini L, Merler S, Natalini G, Piatti A, Ranieri MV, Scandroglio AM, Storti E, Cecconi M, Pesenti A; COVID-19 Lombardy ICU Network. Baselinecharacteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA. 2020;323:1574-81. [PubMed] [Google Scholar]

Vardavas CI, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis. 2020;18:20. [PubMed] [Google Scholar]

Patanavanich R, Glantz SA. Smoking is associated with COVID-19 progression: A meta-analysis. Nicotine Tob Res. 2020;22(9):1653-6. [PubMed] [Google Scholar]

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The Third International Consensus Definitions for sepsis and septic shock (sepsis-3). JAMA. 2016 Feb 23;315(8):801-10. [PubMed] [Google Scholar]

Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001 Oct 10;286(14):1754-8. [PubMed] [Google Scholar]

Gao J, Zhong L, Wu M, Ji J, Liu Z, Wang C, Xie Q, Liu Z. Risk factors for mortality in critically ill patients with COVID-19: a multicenter retrospective case-control study. BMC Infect Dis. 2021;21:602. [PubMed] [Google Scholar]

Tan C, Huang Y, Shi F, Tan K, Ma Q, Chen Y, Jiang X, Li X. C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 early. J Med Virol. 2020 Jul;92(7):856-62. [PubMed] [Google Scholar]