What is the typical clinical course for adult inpatients with COVID-19 and what risk factors predispose these patients to more severe illness and death?

Bottom Line:

Older age, high SOFA (sequential organ failure assessment) score, and significant blood clot formation on admission were risk factors associated with higher odds of in-hospital death identified in older adults hospitalized with COVID-19 in Wuhan.

Reference:

Zhou, F. 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). https://doi.org/10.1016/S0140-6736(20)30566-3

Date Published:

12 March 2020

Synopsis:

This retrospective cohort looked at two groups of adult inpatients with a laboratory-confirmed COVID-19 diagnosis and an outcome of either death or discharge from the Wuhan Pulmonary and Jinyintan Hospitals in Wuhan, China between December 29, 2019 and January 31, 2020. Epidemiological, demographic, laboratory, clinical, treatment, and outcome data from 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included, of whom 54 died and 137 were discharged. Comorbidities were present in 91 (48%) patients, of which hypertension was the most common, then diabetes and coronary heart disease. Identified risk factors for death included older age, a higher SOFA score (signifying end-organ damage), and a d-dimer score >1μg/mL (signifying excessive underlying clotting) on admission. Previous studies looking at older age as a predictor of mortality posited that this association was due to age-dependent defects in immune response (particularly in T- and B-cell function, and excess type 2 cytokine expression). Elevated levels of blood IL-6 (marker of inflammation), high sensitivity cardiac troponin I (indicating underlying cardiac problems), and lactate dehydrogenase (non-specific enzyme found in most body tissues) as well as lymphopenia (low lymphocyte counts) were seen more commonly in patients with severe illness.

Summary by: Kathleen Simms