Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.

Tytuł:: Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.
Autorzy:: Zhou F; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Yu T; Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China.
Du R; Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China.
Fan G; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China.
Liu Y; Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China.
Liu Z; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Xiang J; Department of Clinical Laboratory, Jinyintan Hospital, Wuhan, China.
Wang Y; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China.
Song B; Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China.
Gu X; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China.
Guan L; Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China.
Wei Y; Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China.
Li H; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Wu X; GCP Center, Jinyintan Hospital, Wuhan, China.
Xu J; Tsinghua University School of Medicine, Beijing, China.
Tu S; Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China.
Zhang Y; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Chen H; Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China. Electronic address: .
Cao B; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China; Tsinghua University School of Medicine, Beijing, China. Electronic address: caobin_.
Źródło:: Lancet (London, England) [Lancet] 2020 Mar 28; Vol. 395 (10229), pp. 1054-1062. Date of Electronic Publication: 2020 Mar 11.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: 2004- : London : Elsevier
Original Publication: London : J. Onwhyn
MeSH Terms:: Organ Dysfunction Scores*
Patient Care Planning*
Risk Assessment*/methods
Coronavirus Infections/*mortality
Pneumonia, Viral/*mortality
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Betacoronavirus ; COVID-19 ; COVID-19 Testing ; Cardiovascular Diseases/complications ; China ; Clinical Laboratory Techniques ; Cohort Studies ; Comorbidity ; Coronavirus Infections/complications ; Coronavirus Infections/diagnosis ; Diabetes Complications ; Disease Progression ; Female ; Fibrin Fibrinogen Degradation Products/analysis ; Humans ; Hypertension/complications ; Male ; Middle Aged ; Mortality/trends ; Pandemics ; Patient Isolation ; Pneumonia, Viral/complications ; Pneumonia, Viral/diagnosis ; Prognosis ; Retrospective Studies ; Risk Factors ; SARS-CoV-2 ; Young Adult
References:: N Engl J Med. 2020 Mar 26;382(13):1199-1207. (PMID: 31995857)
JAMA. 2020 Mar 17;323(11):1061-1069. (PMID: 32031570)
Clin Infect Dis. 2018 Jun 18;67(1):8-17. (PMID: 29324996)
Medicine (Baltimore). 2007 Mar;86(2):103-111. (PMID: 17435590)
PLoS Pathog. 2010 Feb 05;6(2):e1000756. (PMID: 20140198)
JAMA. 2013 Oct 23;310(16):1711-20. (PMID: 24150467)
Nephron Clin Pract. 2012;120(4):c179-84. (PMID: 22890468)
N Engl J Med. 2017 Feb 9;376(6):584-594. (PMID: 28177862)
N Engl J Med. 2020 Mar 19;382(12):1177-1179. (PMID: 32074444)
JAMA. 2012 Jun 20;307(23):2526-33. (PMID: 22797452)
Thorax. 2003 Aug;58(8):686-9. (PMID: 12885985)
N Engl J Med. 2016 Sep 29;375(13):1303-5. (PMID: 27682053)
Eur Respir J. 2019 Aug 1;54(2):. (PMID: 31164430)
Mol Med. 2009 Nov-Dec;15(11-12):438-45. (PMID: 19753144)
Eur J Clin Microbiol Infect Dis. 2005 Mar;24(3):165-71. (PMID: 15789222)
Clin Infect Dis. 2016 Sep 1;63(5):e61-e111. (PMID: 27418577)
Lancet Respir Med. 2020 Apr;8(4):420-422. (PMID: 32085846)
JAMA. 2020 Feb 25;323(8):709-710. (PMID: 31999307)
Clin Infect Dis. 2005 Nov 15;41 Suppl 7:S504-12. (PMID: 16237654)
JAMA. 2016 Feb 23;315(8):801-10. (PMID: 26903338)
Clin Infect Dis. 2016 Feb 15;62(4):477-483. (PMID: 26565003)
Am J Physiol Heart Circ Physiol. 2008 Dec;295(6):H2373-9. (PMID: 18849338)
N Engl J Med. 2004 Dec 16;351(25):2611-8. (PMID: 15602021)
Circulation. 2012 Feb 14;125(6):773-81. (PMID: 22219349)
J Infect Dis. 2018 May 5;217(11):1708-1717. (PMID: 29648602)
Expert Rev Anti Infect Ther. 2019 Dec;17(12):939-942. (PMID: 31684779)
Thorax. 2018 Mar;73(3):286-289. (PMID: 28724637)
Am J Emerg Med. 2012 Nov;30(9):1991-9. (PMID: 22795996)
Lancet. 2013 Feb 9;381(9865):496-505. (PMID: 23332146)
Ann Intern Med. 2003 Nov 4;139(9):715-23. (PMID: 14597455)
Lancet. 2020 Feb 15;395(10223):497-506. (PMID: 31986264)
Lancet. 2020 Feb 15;395(10223):507-513. (PMID: 32007143)
Ther Adv Cardiovasc Dis. 2015 Aug;9(4):217-37. (PMID: 26275770)
JAMA. 2001 Oct 10;286(14):1754-8. (PMID: 11594901)
Lancet Respir Med. 2020 May;8(5):475-481. (PMID: 32105632)
Substance Nomenclature:: 0 (Fibrin Fibrinogen Degradation Products)
0 (fibrin fragment D)
Entry Date(s):: Date Created: 20200315 Date Completed: 20200403 Latest Revision: 20230308
Update Code:: 20240105
PubMed Central ID:: PMC7270627
DOI:: 10.1016/S0140-6736(20)30566-3
PMID:: 32171076
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Background: Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described.
Methods: In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.
Findings: 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days.
Interpretation: The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
Funding: Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
(Copyright © 2020 Elsevier Ltd. All rights reserved.)

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