Risk Factors for Death from COVID-19

August 12, 2020

Written by Clay Smith

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COVID-19 was more likely to be fatal in older, male, overweight patients with comorbidities. And patients with more severe lung, liver, or kidney involvement and those in hospitals with fewer ICU beds had greater mortality.

Why does this matter?
COVID-19 is new to planet earth. We are just now learning how it impacts us. What are the demographic, clinical, and hospital variables that might predict mortality?

Older + sicker = worse
This was a prospective cohort study of 2,215 patients admitted to U.S. ICUs at 65 centers. They used multiple logistic regression to determine which factors were independently associated with 28-day mortality from COVID-19. Of the original cohort, 784 (35%) had died by 28 days (up to 39% by the end of the study); 37% were discharged; and 27% were still in the hospital. Mean age was 60, 65% male. Mortality varied widely across hospitals, from 7% to 81%. Race, hypertension, and diabetes were each not independently associated with death.

Risk factors for death were:

• Age (≥80 vs <40 years): OR 11.15 (95% CI 6.19-20.06)

• Male sex: OR 1.50 (95% CI 1.19-1.90)

• Higher body mass index (≥40 vs <25): OR 1.51 (95% CI 1.01-2.25)

• Coronary artery disease: OR, 1.47 (95% CI 1.07-2.02)

• Active cancer: OR 2.15 (95% CI 1.35-3.43)

• Presence of hypoxemia (Pao2:Fio2<100 vs ≥300 mm Hg): OR 2.94 (95% CI 2.11-4.08)

• Liver dysfunction (liver Sequential Organ Failure Assessment score of 2 vs 0): OR 2.61 (95% CI 1.30-5.25)

• Kidney dysfunction (renal Sequential Organ Failure Assessment score of 4 vs 0): OR 2.43 (95% CI 1.46-4.05) at ICU admission

• Smaller ICU (<50 vs ≥100 ICU beds): OR 3.28 (95% CI, 2.16-4.99)

Source
Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US.  JAMA Intern Med. 2020 Jul 15. doi: 10.1001/jamainternmed.2020.3596. [Epub ahead of print]

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