Clinical and Laboratory Factors in Predicting Mortality Among COVID-19 RT-PCR Positive Patients: A Retrospective Observational Study From a Tertiary Care Center.

Abstract

Background: In coronavirus disease 2019 (COVID-19) patients, risk stratification based on clinical presentation, co-morbid illness, and combined laboratory parameters is essential to provide an adequate, timely intervention based on an individual’s conditions to prevent mortality among cases.Methods: A retrospective observational study was carried out from June to October 2020, including all reverse transcription-polymerase chain reaction (RT-PCR) positive COVID-19 non-survivors and control group survivors randomly selected after age and sex matching. Clinical and demographic information was collected from the medical records. Categorical variables were expressed by frequency and percentage. To explore the risk factors associated with mortality, univariable and multivariable logistic regression models were used.Results and discussions: All non-survivors (n = 100) and 100 survivors (out of 1,018) were analyzed. Male gender (67.4%) was the independent risk factor for COVID-19 infection. Advanced age group, diabetes, cardiovascular, neurological, and hypertensive co-morbidities were statistically associated with mortality. Cardiac arrest and acute kidney injury (AKI) were the most common complications. Mortality is significantly associated with lymphopenia and raised lactate dehydrogenase (LDH), as shown by higher odds. In addition, raised neutrophils, monocytes, aspartate aminotransferase (AST), serum creatinine, interleukin 6 (IL-6), and C-reactive protein (CRP) are also significantly associated with mortality. The most common causes of death were respiratory failure (84%) and acute respiratory distress syndrome (77%). Of the non-survivors, 92% received corticosteroids, 63% were on high-flow nasal cannula oxygen therapy, 29% were mechanically ventilated, and 29% received tocilizumab.Conclusion: Serial monitoring of neutrophils, lymphocytes, D-dimer, procalcitonin, AST, LDH, CRP, IL-6, serum creatinine, and albumin might provide a reliable and convenient method for classifying and predicting the severity and outcomes of patients with COVID-19.