Clinical characteristics and predictors of mortality in patients with COVID-19 infection outside intensive care
File(s)
Author(s)
Type
Journal Article
Abstract
Background/introduction
The Coronavirus Disease 2019 (COVID-19) pandemic has affected all aspects of inpatient hospital medicine with patients admitted from Level 1 (general medical wards) through to Level 3 (intensive care). Often, there are subtle physiological differences in these cohorts of patients. In particular, in intensive care, patients tend to be younger and have increased disease severity. Data, to date, has combined outcomes from medical and intensive care cohorts, or looked exclusively at intensive care. We looked solely at the level 1 (medical) cohort to identify their clinical characteristics and predictors of outcome.
Methods
This was a retrospective study of adult patients admitted to a central London teaching hospital with a diagnosis of COVID-19 from 23rd March – 7th April 2020 identified from the hospital electronic database. Any patients who required level 2 or 3 care were excluded.
Results
229 patients were included for analysis. Increased age and frailty scores were associated with increased 30-day mortality. Reduced renal function and elevated troponin blood levels are also associated with poor outcome. Baseline observations showed increased oxygen requirement was predictive for mortality. A trend of increased mortality with lower diastolic blood pressure was noted. Lymphopenia was not shown to be related to mortality.
Conclusion
Urea and creatinine are the best predictors of mortality in the level 1 cohort. Unlike previous intensive care data, lymphopenia is not predictive of mortality. We suggest that these factors be considered when prognosticating and for resource allocation for the treatment and escalation of care for patients with COVID-19 infection.
The Coronavirus Disease 2019 (COVID-19) pandemic has affected all aspects of inpatient hospital medicine with patients admitted from Level 1 (general medical wards) through to Level 3 (intensive care). Often, there are subtle physiological differences in these cohorts of patients. In particular, in intensive care, patients tend to be younger and have increased disease severity. Data, to date, has combined outcomes from medical and intensive care cohorts, or looked exclusively at intensive care. We looked solely at the level 1 (medical) cohort to identify their clinical characteristics and predictors of outcome.
Methods
This was a retrospective study of adult patients admitted to a central London teaching hospital with a diagnosis of COVID-19 from 23rd March – 7th April 2020 identified from the hospital electronic database. Any patients who required level 2 or 3 care were excluded.
Results
229 patients were included for analysis. Increased age and frailty scores were associated with increased 30-day mortality. Reduced renal function and elevated troponin blood levels are also associated with poor outcome. Baseline observations showed increased oxygen requirement was predictive for mortality. A trend of increased mortality with lower diastolic blood pressure was noted. Lymphopenia was not shown to be related to mortality.
Conclusion
Urea and creatinine are the best predictors of mortality in the level 1 cohort. Unlike previous intensive care data, lymphopenia is not predictive of mortality. We suggest that these factors be considered when prognosticating and for resource allocation for the treatment and escalation of care for patients with COVID-19 infection.
Date Issued
2020-11-17
Date Acceptance
2020-10-19
Citation
International Journal of General Medicine, 2020, 2020 (13), pp.1157-1165
ISSN
1178-7074
Publisher
Dove Medical Press
Start Page
1157
End Page
1165
Journal / Book Title
International Journal of General Medicine
Volume
2020
Issue
13
Copyright Statement
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.
License URL
Identifier
https://www.dovepress.com/clinical-characteristics-and-predictors-of-mortality-in-patients-with--peer-reviewed-article-IJGM
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
COVID-19
mortality
frailty
ICU
renal dysfunction
lymphopenia
CELL
RESOLUTION
APOPTOSIS
COVID-19
ICU
frailty
lymphopenia
mortality
renal dysfunction
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2020-11-17