TY - JOUR
AU - Maguire, Donogh
AU - Woods, Marylynne
AU - Richards, Conor
AU - Dolan, Ross
AU - Wilson Veitch, Jesse
AU - Sim, Wei M.J.
AU - Kemmett, Olivia E.H.
AU - Milton, David C.
AU - Randall, Sophie L.W.
AU - Bui, Ly D.
AU - Goldmann, Nicola
AU - Cameron, Allan
AU - Laird, Barry J.
AU - Talwar, Dinesh
AU - Godber, Ian M.
AU - Davidson, Alan
AU - McMillan, Donald C.
PY - 2020
DA - September
TI - Prognostic factors in patients admitted to an urban teaching hospital with COVID-19 infection
JO - Journal of Translational Medicine
VL - 18
IS - 1
DO - http://dx.doi.org/10.1186/s12967-020-02524-4
AB - Background: Severe COVID-19 infection results in a systemic inflammatory response (SIRS). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure. Methods: Electronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020—1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age, sex, BMI and documented evidence of COVID-19 infection at time of discharge or death certification were considered minimal criteria for inclusion. Results: Of the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure (75%) and multiorgan failure (12%) were the commonest causes of death recorded. Age ≥ 70 years (p &lt; 0.001), past medical history of cognitive impairment (p ≤ 0.001), previous delirium (p &lt; 0.001), clinical frailty score &gt; 3 (p &lt; 0.001), hypertension (p &lt; 0.05), heart failure (p &lt; 0.01), national early warning score (NEWS) &gt; 4 (p &lt; 0.01), positive CXR (p &lt; 0.01), and subsequent positive COVID-19 swab (p ≤ 0.001) were associated with 30-day mortality. CRP &gt; 80 mg/L (p &lt; 0.05), albumin &lt; 35 g/L (p &lt; 0.05), peri-operative Glasgow Prognostic Score (poGPS) (p &lt; 0.05), lymphocytes &lt; 1.5 109/l (p &lt; 0.05), neutrophil lymphocyte ratio (p ≤ 0.001), haematocrit (&lt; 0.40 L/L (male)/ &lt; 0.37 L/L (female)) (p ≤ 0.01), urea &gt; 7.5 mmol/L (p &lt; 0.001), creatinine &gt; 130 mmol/L (p &lt; 0.05) and elevated urea: albumin ratio (&lt; 0.001) were also associated with 30-day mortality. On multivariate analysis, age ≥ 70 years (O.R. 3.9, 95% C.I. 1.4–8.2, p &lt; 0.001), past medical history of heart failure (O.R. 3.3, 95% C.I. 1.2–19.3, p &lt; 0.05), NEWS &gt; 4 (O.R. 2.4, 95% C.I. 1.1–4.4, p &lt; 0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2–0.9, p &lt; 0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1–4.4, p &lt; 0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n = 122), age ≥ 70 years (O.R. 4.7, 95% C.I. 2.0—11.3, p &lt; 0.001), past medical history of heart failure (O.R. 4.4, 95% C.I. 1.2–20.5, p &lt; 0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1–5.1, p &lt; 0.05) remained independently associated with 30-days mortality. Conclusion: Age ≥ 70 years and severe systemic inflammation as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection.
PB - BioMed Central
UR - http://eprints.gla.ac.uk/218762/
KW - Coronavirus (COVID-19)
ER