Predictors of mortality among inpatients with COVID-19 infection in a tertiary referral center in the Philippines
IJID Regions, doi:10.1016/j.ijregi.2022.07.009
Objectives: The aim of this study was to determine the predictors of mortality and describe laboratory trends among adults with confirmed COVID-19. Methods: The medical records of adult patients admitted to a referral hospital with COVID-19 were retrospectively reviewed. Demographic and clinical characteristics, and laboratory parameters, were compared between survivors and non-survivors. Predictors of mortality were determined by multivariate analysis. Mean laboratory values were plotted across illness duration. Results: Of 1215 patients, 203 (16.7%) had mild, 488 (40.2%) moderate, 183 (15.1%) severe, and 341 (28.1%) critical COVID-19 on admission. In-hospital mortality was 18.2% (0% mild, 6.1% moderate, 15.8% severe, 47.5% critical). Predictors of mortality were age ≥ 60 years, COPD, qSOFA score ≥ 2, WBC > 10 × 10 9 /L, absolute lymphocyte count < 1000, neutrophil ≥ 70%, PaO 2 /FiO 2 ratio ≤ 200, eGFR < 90 mL/min/1.73 m 2 , LDH > 600 U/L, and CRP > 12 mg/L. Non-survivors exhibited an increase in LDH and decreases in PaO 2 /FiO 2 ratio and eGFR during the 2nd-3rd week of illness.
Conclusion: The overall mortality rate was high. Predictors of mortality were similar to those of other reports globally. Marked inflammation and worsening pulmonary and renal function were evident among non-survivors by the 2nd-3rd week of illness.
AUTHOR CONTRIBUTIONS Conceptualization/investigation -all authors; data collection -AGM, JMS, JBP, JGP, SLM, RWG, AME, JAC, JAS, JTM; data validation -AGM, JMS; data analysis -AGM, CRA, MSS, MMA, MPM; resources/software -AGM, MPM; supervision -MMA, MSS, CRA, JAC; writing, original draft -AGM, JBP, RWG, RDR, EBO; writing, review and editing -AGM, CRA, MSS, MMA.
ETHICAL APPROVAL The study was conducted with regulatory approval by the Institutional Review Board of UP-Manila.
Declaration of Competing Interest The authors declare no conflicts of interest.
Supplementary materials Supplementary material associated with this article can be found, in the online version, at doi: 10.1016/j.ijregi.2022.07.009 .
Abad, Lansang, Cordero, Viray, Tiangco et al., Early experience with COVID-19 patients in a private tertiary hospital in the Philippines: implications on surge capacity, healthcare systems response, and clinical care, Clin Epidemiol Glob Health, doi:10.1016/j.cegh.2020.100695
Alenezi, Almeshari, Mahida, Bangash, Thickett et al., Incidence and risk factors of acute kidney injury in COVID-19 patients with and without acute respiratory distress syndrome (ARDS) during the first wave of COVID-19: a systematic review and Meta-Analysis, Ren Fail, doi:10.1080/0886022X.2021.2011747
Bajo, Philippine COVID-19 cases underreported
Balagtas, Rodrigo Duterte is using one of the world's longest COVID-19 lockdowns to strengthen his grip on the Philippines, TIME
Bellan, Patti, Hayden, Azzolina, Pirisi et al., Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients, Sci Rep, doi:10.1038/s41598-020-77698-4
Bienvenu, Noonan, Wang, Peter, Higher mortality of COVID-19 in males: sex differences in immune response and cardiovascular comorbidities, Cardiovasc Res, doi:10.1093/cvr/cvaa284
Challen, Brooks-Pollock, Read, Dyson, Tsaneva-Atanasova et al., Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study, BMJ, doi:10.1136/bmj.n579
Delshad, Tavakolinia, Pourbagheri-Sigaroodi, Safaroghli-Azar, Bagheri et al., The contributory role of lymphocyte subsets, pathophysiology of lymphopenia and its implication as prognostic and therapeutic opportunity in COVID-19, Int Immunopharmacol, doi:10.1016/j.intimp.2021.107586
Espiritu, Sy, Anlacan, Jamora, Macalintal, Philippine CORONA Study Group Investigators. COVID-19 outcomes of 10,881 patients: retrospective study of neurological symptoms and associated manifestations (Philippine CORONA Study), J Neural Transm, doi:10.1007/s00702-021-02400-5
Fallesen, How COVID-19 impacted vulnerable communities in the Philippines, World Bank Blogs
Garibaldi, Fiksel, Muschelli, Robinson, Rouhizadeh et al., Patient trajectories among persons hospitalized for COVID-19: a cohort study, Ann Intern Med, doi:10.7326/M20-3905
Henry, De Oliveira, Benoit, Plebani, Lippi, Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis, Clin Chem Lab Med CCLM, doi:10.1515/cclm-2020-0369
Holman, Knighton, Kar, 'keefe, Curley et al., Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study, Lancet Diabetes Endocrinol, doi:10.1016/S2213-8587(20)30271-0
Izcovich, Ragusa, Tortosa, Marzio, Agnoletti et al., Prognostic factors for severity and mortality in patients infected with COVID-19: a systematic review, PLOS ONE, doi:10.1371/journal.pone.0241955
Jin, Agarwala, Kundu, Harvey, Zhang et al., Individual and community-level risk for COVID-19 mortality in the United States, Nat Med, doi:10.1038/s41591-020-01191-8
Katzenschlager, Zimmer, Gottschalk, Grafeneder, Schmitz et al., Can we predict the severe course of COVID-19 -a systematic review and metaanalysis of indicators of clinical outcome?, PLOS ONE, doi:10.1371/journal.pone.0255154
Lee, Son, Han, Park, Jung, Impact of COPD on COVID-19 prognosis: a nationwide population-based study in South Korea, Sci Rep, doi:10.1038/s41598-021-83226-9
Malik, Patel, Mehta, Patel, Kelkar et al., Biomarkers and outcomes of COVID-19 hospitalisations: systematic review and meta-analysis, BMJ Evid-Based Med, doi:10.1136/bmjebm-2020-111536
Mesas, Cavero-Redondo, Álvarez-Bueno, Cabrera, De Andrade et al., Predictors of in-hospital COVID-19 mortality: a comprehensive systematic review and meta-analysis exploring differences by age, sex and health conditions, PLOS ONE, doi:10.1371/journal.pone.0241742
Mikami, Miyashita, Yamada, Harrington, Steinberg et al., Risk factors for mortality in patients with COVID-19 in New York City, J Gen Intern Med, doi:10.1007/s11606-020-05983-z
Mohamed, Benn, Astha, Okhawere, Korn et al., Association between chronic kidney disease and COVID-19-related mortality in New York, World J Urol, doi:10.1007/s00345-020-03567-4
Penna, Mercurio, Tocchetti, Pagliaro, Sex-related differences in COVID-19 lethality, Br J Pharmacol, doi:10.1111/bph.15207
Potere, Valeriani, Candeloro, Tana, Porreca et al., Acute complications and mortality in hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis, Crit Care, doi:10.1186/s13054-020-03022-1
Salamat, Malundo, Abad, Sandejas, Planta et al., Characteristics and factors associated with mortality of 200 COVID-19 patients at a Philippine COVID-19 tertiary referral center, Acta Med Philipp, doi:10.47895/amp.v55i2.2845
Salva, Villarama, Lopez, Sayo, Villanueva et al., Epidemiological and clinical characteristics of patients with suspected COVID-19 admitted in Metro Manila, Philippines, Trop Med Health, doi:10.1186/s41182-020-00241-8
Shi, Wang, Ye, Gu, Wang et al., Predictors of mortality in patients with coronavirus disease 2019: a systematic review and meta-analysis, BMC Infect Dis, doi:10.1186/s12879-021-06369-0
Sung, Kim, Heo, Seo, Jang et al., Clinical course and outcomes of 3,060 patients with coronavirus disease 2019 in Korea, January-May 2020, J Korean Med Sci, doi:10.1056/NEJMoa2021436
Venkatraja, Srilakshminarayana, Kumar, The dominance of severe acute respiratory syndrome coronavirus 2 B.1.617 and its sublineages and associations with mortality during the COVID-19 pandemic in India between 2020 and 2021, Am J Trop Med Hyg, doi:10.4269/ajtmh.21-0812
Zhou, Yu, Du, Fan, Liu et al., Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, The Lancet, doi:10.1016/S0140-6736(20)30566-3