Clinical Predictors of Mortality and Critical Illness in Patients with COVID-19 Pneumonia.

Maamoun Basheer,Rechnitzer Hagai,Elias Saad,Nimer Assy

doi:10.3390/metabo11100679

Maamoun Basheer, Rechnitzer Hagai + Show 2 more

Open Access

https://doi.org/10.3390/metabo11100679

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Journal: Metabolites	Publication Date: Oct 2, 2021
Citations: 15	License type: CC BY 4.0

Affiliation: Western Galilee Hospital, Bar-Ilan University

Abstract

Early identification of patients with COVID-19 who will develop severe or critical disease symptoms is important for delivering proper and early treatment. We analyzed demographic, clinical, immunological, hematological, biochemical and radiographic findings that may be of utility to clinicians in predicting COVID-19 severity and mortality. Electronic medical record data from patients diagnosed with COVID-19 from November 2020 to June 2021 in the COVID-19 Department in the Galilee Medical Center, Nahariya, Israel, were collected. Epidemiologic, clinical, laboratory and imaging variables were analyzed. Multivariate stepwise regression analyses and discriminant analyses were used to identify and validate powerful predictors. The main outcome measure was invasive ventilation, or death. The study population included 390 patients, with a mean age of 61 ± 18, and 51% were male. The non-survivors were mostly male, elderly and overweight and significantly suffered from hypertension, diabetes mellitus type 2, lung disease, hemodialysis and past use of aspirin. Four predictive factors were found that associated with increased disease severity and/or mortality: age, NLR, BUN, and use of high flow oxygen therapy (HFNC). The AUC or diagnostic accuracy was 87%, with a sensitivity of 97%, specificity of 60%, PPV of 87% and NPP of 91%. The cytokine levels of CXCL-10, GCSF, IL-2 and IL-6 were significantly reduced upon the discharge of severely ill COVID-19 patients. The predictive factors associated with increased mortality include age, NLR, BUN, and use of HFNC upon admission. Identifying those with higher risks of mortality could help in early interventions to reduce the risk of death.

Highlights

People infected with SARS-CoV-2 may develop COVID-19, which has a wide range of clinical severity, from a mild upper respiratory tract inflammation to a diffuse viral pneumonia causing acute respiratory failure, including lung injury, multiorgan failure, sepsis and death [1,2,3]
According to the NIH management guidelines, 80% of the COVID-19 patients worldwide were classified as mild, 14% severe, and 5% as critical illness such as septic shock and acute respiratory distress syndrome (ARDS) [1,2,3]
Our study shows that high Neutrophil to lymphocyte ratio (NLR) correlates with the disease severity and mortality of the COVID-19 patients

Summary

Introduction

People infected with SARS-CoV-2 may develop COVID-19, which has a wide range of clinical severity, from a mild upper respiratory tract inflammation to a diffuse viral pneumonia causing acute respiratory failure, including lung injury, multiorgan failure, sepsis and death [1,2,3]. According to the NIH management guidelines, 80% of the COVID-19 patients worldwide were classified as mild (fever, cough, malaise), 14% severe (pneumonia and hypoxemia), and 5% as critical illness such as septic shock and acute respiratory distress syndrome (ARDS) [1,2,3]. Patients need support for many of the common complications of severe COVID-19, including pneumonia, hypoxemic respiratory failure, ARDS, sepsis, septic shock and acute kidney injury. The average case fatality rate in China was 2.3%, but mortality was as high as 49% in patients with critical illness [11]

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Discussion

Conclusion