Variables Affecting Mortality Among COVID-19 Patients With Lung Involvement Admitted to the Emergency Department

Cureus. 2021 Jan 7;13(1):e12559. doi: 10.7759/cureus.12559.


Introduction: A cluster of atypical pneumonia cases in Wuhan, China, turned out to be a highly contagious disease, swept across most of the countries, and soon after was announced as a pandemic. Therefore we aimed to investigate the demographics and factors associated with the disease outcome.

Methods: In this retrospective chart review, we screened patients admitted to the emergency department with severe acute respiratory infection due to coronavirus disease 2019 (COVID-19) between March 15, 2020 and April 30, 2020. Age, gender, symptoms, laboratory data, and radiology data were obtained, as well as outcomes and length of stay.

Results: We identified 177 patients (54.8% male). Seventy-eight percent of the cases were admitted into wards whereas 22% of the cases were admitted into the intensive care unit (ICU). Twenty-five percent of the cases needed invasive mechanical ventilation during their hospital stay and median length of hospital stay until death or discharge was eight days (interquartile range (IQR) 5.0 - 16.0). Among 177 patients, overall in-hospital mortality rate was 19.8% (n=35; male:female=18:17; p=0.6553). In-hospital mortality rates were statistically significantly higher in patients with higher age (64 vs. 74; p=0.0091), respiratory rate (RR) (28 vs. 36; p=0.0002), C-reactive protein (CRP) (54.7 vs. 104.0; p<0.0001), d-dimer (1.2 vs. 3.2; p<0.0001), ferritin (170 vs. 450.4; p<0.0001), fibrinogen (512 vs. 598; p=0.0349), international normalized ratio (INR) (1.1 vs. 1.3; p=0.0001), prothrombin time (PT) (14.8 vs. 17.4; p=0.0001), procalcitonin (0.1 vs. 0.3; p<0.0001), creatinine (0.9 vs. 1.1; p=0.0084), longer length of stay (LOS) (8.0 vs. 13.0; p=0.0251) with lower oxygen saturation (sO2) (93.0% vs 87.5%; p<0.0001), diastolic blood pressure (DBP) (78 vs. 70; p=0.0039), lymphocyte (1.2 vs. 0.8; p=0.0136), and with positive polymerase chain reaction (PCR) results (28.6% vs. 12.8%; p=0.0118).

Conclusion: Patients with older age, higher RR, lower sO2 and DBP, higher creatinine, d-dimer, INR, CRP, procalcitonin, ferritin, and fibrinogen on initial admission were found to be less likely to survive COVID-19.

Keywords: covid-19; mortality; outcomes.