Advanced age, dyspnea, heart disease risk factors for fatal outcome from COVID-19

A team of researchers created a prognostic nomogram that accurately predicted risk factors associated with mortality in hospitalized patients with COVID-19 based on individual features, according to data published in Chest.

“As the pandemic evolves, it is urgent that the risk factors associated with fatal outcomes be identified,” Ruchong Chen, MD, of the National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health at the First Affiliated Hospital of Guangzhou Medical University, China, and colleagues wrote. “Our study unraveled the clinic features and risk factors for fatal outcome in subjects with laboratory-confirmed COVID-19 based on a national cohort.”

Chen and colleagues analyzed a retrospective cohort of 1,590 hospitalized patients with COVID-19, which represented 13.5% of patients with COVID-19 in China. Researchers analyzed clinical features and laboratory findings using Kaplan-Meier methods and a Cox regression analysis. They then created a prognostic nomogram to predict survival and risk factors associated with COVID-19 mortality.

Fifty deaths (median age, 69 years; 30 men) were reported by January. One or more coexisting illnesses were reported in 70% of cases, including hypertension (56%), diabetes (26%), coronary heart disease (16%), cardiovascular disease (12%), COPD (12%) and renal disease (10%). Overall confirmed case fatality ratio was 3.14% in this cohort.

There were a higher incidence of older patients and individuals with coexisting chronic illness, dyspnea and laboratory abnormalities at admission in nonsurvivors compared with survivors.

Multivariate Cox regression analysis showed the following as independent risk factors associated with fatal COVID-19 outcome: age 75 years or older (HR = 7.86; 95% CI, 2.44-25.35), age 65 to 74 years (HR = 3.43; 95% CI, 1.24-9.5), coronary heart disease (HR = 4.28; 95% CI, 1.14-16.13), CVD (HR = 3.1; 95% CI, 1.07-8.94), dyspnea (HR = 3.96; 95% CI, 1.42-11), procalcitonin level of 0.5 ng/mL or greater (HR = 8.72; 95% CI, 3.42-22.28) and aspartate aminotransferase level of 40 U/L or greater (HR = 2.2; 95% CI, 1.1-6.73).

Researchers established the nomogram based on the multivariate analysis results, with the aim to predict the probability of COVID-19 survival at 14, 21 and 28 days. The C-index for prediction of overall survival was 0.91 (95% CI, 0.85-0.97), which was consistent with actual observation of patients with COVID-19, the researchers wrote.

“The current study provides evidence that advanced age, dyspnea, coronary heart disease, CVD, and elevated procalcitonin and aspartate aminotransferase levels are independent risk factors associated with fatal outcome,” the researchers wrote. “Earlier identification, more intensive surveillance and appropriate therapy should be considered in these patients at high risk.”