Clinical features and short-term outcomes of COVID-19 in Tehran, Iran: An analysis of mortality and hospital stay
Keywords:
COVID-19, SARS-CoV-2, Mortality, Hospitalization, Risk factorsAbstract
Background
The sudden outbreak of the COVID-19 disease originated in Wuhan, China, in December 2019. There have been few reports of the clinical course of the disease, but detailed information on the risk factors for increased hospital stay and mortality is not available. In this study, we aimed to present the details of 53 confirmed COVID-19 cases to share the clinical course and the risk factors for longer hospital stay and death.
Methods
In this study, we enrolled fifty-three patients with confirmed COVID-19 infection from a referral academic hospital in Tehran, Iran admitted between March and April 2020. Patients’ demographics, laboratory tests, treatments, length of hospital stay (LOHS), and final outcome were recorded and analyzed.
Results
Fifty-three patients were included in this study. The higher LOHS was associated with clinical symptoms, including hemoptysis (IRR= 0.73, P-value= 0.02), diarrhea (IRR= 0.78, P-value= 0.01), headache (IRR= 0.81, P-value= 0.05), and dry cough (IRR= 0.82, P-value= 0.05). Mortality was associated with older age(Odds ratio=1.148, 95%CI=1.032-1.276), lower calcium level (Odds ratio=0.087, 95%CI=0.010-0.788), lower serum albumin (Odds ratio=0.036, 95%CI=0.002-0.655), as well as increased level of neutrophil/lymphocyte ratio (NLR) (Odds ratio=1.468, 95%CI=1.086-1.985), lactate dehydrogenase (LDH) (Odds ratio=1.004, 95%CI=1.000-1.007), and urea (Odds ratio=1.023, 95%CI=1.006-1.039).
Conclusion
Our study identified that decreased levels of O2saturation, platelet count, calcium, albumin, and increased NLR, LDH, urea, and old age were correlated with mortality. Also, LOHS was significantly associated with clinical findings, such as hemoptysis and diarrhea.
References
Huang C. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with. 2019:497-506.
Johns Hopkins C. Coronavirus COVID-19 Global Cases. 2020.
Musa TH, Ahmad T, Khan M, Haroon H, Wei P. Global outbreak of 2019-nCoV, a new challenge? The Journal of Infection in Developing Countries. 2020;14:244-5.
Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. The Lancet. 2020;395:565-74.
Richman DD, Whitley RJ, Hayden FG. Clinical virology: John Wiley & Sons; 2016.
Singhal T. A review of coronavirus disease-2019 (COVID-19). The Indian Journal of Pediatrics. 2020:1-6.
Fox SE, Akmatbekov A, Harbert JL, Li G, Brown JQ, Vander Heide RS. Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans. MedRxiv. 2020.
Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. Jama.
Chen J, Qi T, Liu L, Ling Y, Qian Z, Li T, et al. Clinical progression of patients with COVID-19 in Shanghai, China. Journal of Infection. 2020.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020.
Chen X, Shang Y, Yao S, Liu R, Liu H. Perioperative care provider’s considerations in managing patients with the COVID-19 infections. Transl Perioper Pain Med. 2020;7:216-23.
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. New England Journal of Medicine. 2020.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020;395:507-13.
COVID C, Team R. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:343-6.
Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). International Journal of Surgery. 2020.
Xiong M, Liang X, Wei YD. Changes in Blood Coagulation in Patients with Severe Coronavirus Disease 2019 (COVID-19): a Meta-Analysis. British journal of haematology. 2020.
Schmitt FCF, Manolov V, Morgenstern J, Fleming T, Heitmeier S, Uhle F, et al. Acute fibrinolysis shutdown occurs early in septic shock and is associated with increased morbidity and mortality: results of an observational pilot study. Annals of intensive care. 2019;9:19.
Han H, Yang L, Liu R, Liu F, Wu K-l, Li J, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clinical Chemistry and Laboratory Medicine (CCLM). 2020;1.
Akca S, Haji-Michael P, De Mendonça A, Suter P, Levi M, Vincent J-L. Time course of platelet counts in critically ill patients. Critical care medicine. 2002;30:753-6.
Tan L, Wang Q, Zhang D, Ding J, Huang Q, Tang Y-Q, et al. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal transduction and targeted therapy. 2020;5:1-3.
Han Y, Zhang H, Mu S, Wei W, Jin C, Xue Y, et al. Lactate dehydrogenase, a Risk Factor of Severe COVID-19 Patients. medRxiv. 2020.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395:497-506.
Ding J, Karp JE, Emadi A. Elevated lactate dehydrogenase (LDH) can be a marker of immune suppression in cancer: Interplay between hematologic and solid neoplastic clones and their microenvironments. Cancer Biomarkers. 2017;19:353-63.
ZALOGA GP, CHERNOW B. The multifactorial basis for hypocalcemia during sepsis: Studies of the parathyroid hormone-vitamin D axis. Annals of internal medicine. 1987;107:36-41.
Chernow B, Zaloga G, McFADDEN E, Clapper M, Kotler M, Barton M, et al. Hypocalcemia in critically ill patients. Critical care medicine. 1982;10:848-51.
XIANG J, WEN J, YUAN X, Xiong S, ZHOU X, LIU C, et al. Potential biochemical markers to identify severe cases among COVID-19 patients. medRxiv. 2020:2020.03.19.20034447.
Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? The Lancet Respiratory Medicine. 2020.
Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus. Journal of virology. 2020;94.
Li XC, Zhang J, Zhuo JL. The vasoprotective axes of the renin-angiotensin system: Physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases. Pharmacological research. 2017;125:21-38.
Reinhardt GF, Myscofski JW, Wilkens DB, Dobrin PB, Mangan JR JE, Stannard RT. Incidence and mortality of hypoalbuminemic patients in hospitalized veterans. Journal of Parenteral and Enteral Nutrition. 1980;4:357-9.
Watkins J. Preventing a covid-19 pandemic. BMJ. 2020;368:m810.
Liu BC, Gao J, Li Q, Xu LM. Albumin caused the increasing production of angiotensin II due to the dysregulation of ACE/ACE2 expression in HK2 cells. Clinica chimica acta; international journal of clinical chemistry. 2009;403:23-30.
Assiri A, McGeer A, Perl TM, Price CS, Al Rabeeah AA, Cummings DA, et al. Hospital outbreak of Middle East respiratory syndrome coronavirus. New England Journal of Medicine. 2013;369:407-16.
Guarner J. Three Emerging Coronaviruses in Two Decades: The Story of SARS, MERS, and Now COVID-19. American Journal of Clinical Pathology. 2020;153:420-1.
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