Identification of Risk Factors for in-Hospital Death of COVID - 19 Pneumonia

Abstract Objective: To examine the clinical characteristics and identify independent risk factors for in-hospital mortality of 2019 novel coronavirus (COVID-19) pneumonia.Methods: A total of 156 patients diagnosed with COVID-19 pneumonia at the central Hospital of Wuhan from January 29, 2020, to March 20, 2020 were enrolled in this single-centered retrospective study. Their epidemiological parameters, clinical presentations, underlying diseases, laboratory test results and disease outcomes were collected and analyzed.Results: The median age of enrolled patients was 66. Underlying diseases were identified in 101 patients, with hypertension being the most common one, followed by cardiovascular disease and diabetes. The most common symptoms identified upon admission were fever, cough, dyspnea and fatigue. Compared to survival cases, patients who dead during hospitalization had higher plasma levels of D-dimer, creatinine, creatine kinase, lactate dehydrogenase, lactate and lower percentage of lymphocytes (LYM [%]), platelet count and albumin levels. Most enrolled patients received anti-biotics and anti-viral treatment. In addition, 60 patients received corticosteroid and 51 received intravenous immunoglobulin infusion. 44 patients received noninvasive ventilation, 19 received invasive ventilation. Respiratory failure was the most frequently observed complication (106 [67.9%]), followed by sepsis (103 [66.0%]), acute respiratory distress syndrome (ARDS) (67 [42.9%]) and septic shock (50 [32.1%]). Multivariable regression suggested that advanced age (OR [odds ratio]= 1.059, 95% CI [confidence interval]: 1.011-1.110, P= 0.016) and elevated lactate level upon admission (OR= 2.411, 95% CI: 1.177-4.941, P= 0.016) were independent risk factors for in-hospital mortality for COVID-19 infection. Meanwhile, increased LYM (%) at admission (OR= 0.798, 95% CI: 0.728-0.876, P< 0.001) indicated a better prognosis. Conclusions: In this study, we discovered that age, LYM (%) and lactate level upon admission were independent factors that could influence in-hospital mortality rate.