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

https://doi.org/10.1016/j.jaci.2020.04.006Get rights and content

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.

Key words

COVID-19
SARS-CoV-2
risk factors
severity
mortality

Abbreviations used

ACE 2
Angiotensin-converting enzyme 2
ARDS
Acute respiratory distress syndrome
COVID-19
Coronavirus disease 2019
CT
Computed tomography
HR
Hazard ratio
LDH
Lactate dehydrogenase
OR
Odds ratio
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2

Cited by (0)

This project was supported by grants from the Science and Technology Program of Hubei Province (grant no. 2020FCA026).

Disclosure of potential conflict of interest: H. Renz is a member of and receives funding from the German Lung Centre (Deutsches Zentrum für Lungenforschung [DZL]) and of the Universities Giessen and Marburg Lung Centre. The rest of the authors declare that they have no relevant conflicts of interest.

These authors contributed equally to this work.

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