In a recent study published in International Journal of Environmental Research and Public Health Researchers identified independent factors associated with early and late deaths in inpatients with coronavirus disease 2019 (COVID-19).
By March 2022, COVID-19 claimed over 6 million lives worldwide. This fatal infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly contagious and shows acute life-threatening symptoms in some individuals, especially immunocompromised and hospitalized patients.
Several studies have examined the clinical condition of hospitalized COVID-19 patients. In a study conducted in France, the research team found that the median time from admission to the intensive care unit (ICU) to death was 14 days in patients with COVID-19; and the time of death varied according to sequelae and the severity of the disease.
Determining and understanding the mortality predictions regarding the time of death in COVID-19 patients could provide much-needed evidence to aid the clinical management of these patients.
About the study
In this cohort study, researchers identified the factors associated with mortality in COVID-19 patients admitted to Taipei City Hospital (TCH) in Taipei, Taiwan between May 14 and July 31, 2021. The research team recruited COVID-19 patients aged 18 or over with a positive reverse transcriptase polymerase chain reaction (RT-PCR) assay. Follow-up with the examination patients continued until death, discharge from the hospital or until 13 August 2021.
The primary variable of interest for the study was treatment outcome, categorized as successful treatment or mortality; they classified additional mortality – as early or late death. According to the definitions of the study, early death referred to mortality within the first two weeks after hospitalization, and late death referred to mortality after two weeks of hospitalization.
The covariates of the study included sociodemographic characteristics (age and gender) and comorbidities. The researchers analyzed the demographic data from the study participants and presented them as standard deviation (SD). They used a one-way analysis of variance (ANOVA) for comparisons between groups.
The team calculated odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) to assess the gross associations of factors related to mortality. Additionally, the adjusted ORs (AORs) reported 95% CIs to indicate the strength and direction of the relationship between factors related to mortality.
They also performed a gender-based subgroup analysis to determine the factors associated with mortality. In addition, using multinomial logistic regression, they examined the factors associated with early and late death among these patients.
The cohort study included 831 COVID-19 patients with a total mean age of 59.3 years; 49% of these patients were men and 12.2% died during hospitalization. Of the 101 deceased COVID-19 patients in particular, 66 (65.3%) and 35 (34.7%) died early and late, respectively.
The deceased patients were older, more likely men and suffered from a higher proportion of cancer rates, heart failure as well as end-stage renal disease. These patients were also more likely to be admitted to the intensive care unit and receive intubation treatment.
After adjusting for demographics, comorbidities, and disease severity, the univariate and multivariate analyzes showed AOR values (with 95% CIs) for independent predictors of mortality, including age ≥ 65 years, heart failure, and end-stage renal disease as 6.47, 11, respectively. , 67 and 18.67.
The subgroup analysis results showed that age ≥ 65 years was associated with a higher risk of mortality in both male and female COVID-19 patients; likewise, heart failure and end-stage renal disease were the predictors of mortality in male patients.
Taken together, the results of the study showed that the overall mortality risk in inpatients with COVID-19 was unusually high. In particular, two-thirds of COVID-19 deaths occurred within two weeks of hospitalization, and the median time observed from hospitalization to death was six days in such cases.
As the clinical condition of inpatients may deteriorate rapidly, it is essential to monitor their clinical symptoms during treatment, especially in the elderly and those with comorbidity.
The observed in-hospital mortality of 12.2% among inpatients was almost 11.1% and 12.0% among inpatients with COVID-19 in the United States and the United Kingdom, respectively.
Age over 65 years was found to be an independent predictor of early and late death in patients with COVID-19. In addition, age-related defects in T-cell and B cell function may explain the high mortality in elderly patients with COVID-19. Therefore, the authors recommended prioritizing the elderly for antiviral therapy with sotrovimab, molnupiravir and paxlovid to reduce the risk of mortality.
Previous studies showed that the male sex was associated with an increased expression of angiotensin-converting enzyme 2 (ACE2), which is known to be associated with severe COVID-19.
Therefore, it is also recommended to monitor male patients with COVID-19 for their clinical condition during hospitalization. Likewise, COVID-19 patients with end-stage heart failure or renal disease should be considered as priority groups for COVID-19 treatment.