Study Investigates COVID-19 Mortality, Early Indicators of Poor Prognosis

April 8, 2020

As COVID-19 continues to spread, and the death toll rises, experts aim to better understand the clinical features of the disease and factors for increased mortality.

A new study of data from China found that the majority of fatality cases associated with the novel coronavirus disease 2019 (COVID-19) were men aged over 50 years old with noncommunicable chronic diseases.

As COVID-19 continues to spread, and the death toll rises, experts aim to better understand the clinical features of the disease and factors for increased mortality.

Increasing evidence has shown that the virus “induces excessive and aberrant non-effective host immune responses associated with severe lung injury,” the study’s authors wrote. Higher rates of acute respiratory distress syndrome (ARDS) have been observed in older patients with comorbidities. In this study, the authors aimed to identify the clinical characteristics that may serve as markers for poor prognosis at an early stage.

The study was conducted in 2 hospitals in Wuhan, China, and included patients with confirmed COVID-19 who were admitted between January 9 and February 15, 2020. The authors used epidemiological, clinical, laboratory, and radiological test results, as well as clinical management data, using data collection forms from electronic medical records.

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In total, 85 fatal cases with clinically diagnosed COVID-19 were included in the study. Of the 85 patients, 68.2% had 1 or more comorbidities, with hypertension (37.6%), diabetes (22.4%), and coronary heart disease (11.8%) being the most common. On admission, 81.2% of patients had very low eosinophil counts. In the study, 89.3% of the patients who died were over the age of 52 years old and 72.9% were male patients. Additionally, the use of a combination of more than 3 anti-microbial drugs did not appear to offer any benefit to the outcome of patient group in the study.

The authors reported that the fatal cases included in the study accounted for 2.7% of the total mortality due to SARS-CoV-2 infection in Hubei province.

Most of the patients presented upon admission with fever (91.8%) and dyspnea (70.6%), two thirds of patients had shortness of breath (58.8%) and fatigue (58.8%). Approximately half of patients had anorexia and more than one third of patients had expectoration (37.6%). Overall, the duration from first symptoms to hospital admission and ARDS were 10.1 ± 6.2 days and 10.3 ± 6.6 days, respectively, according to the findings.

The authors wrote that “it is worth that the overall rates of shortness of breath in our cohort were higher than that in SARS patients,” which may point to early onset of shortness of breath as an indicator of poor prognosis.

The authors did note limitations for the study, such as only fatal cases were included in the analysis and pathological findings were not available. Additionally, although eosinophilia was found in almost all patients in the study, it can also occur in many non-fatal severe and moderate patients based on clinical observations.

The findings are consisent with other studies and clinical observations regarding the risk of mortality associated with COVID-19 complications. Still, recent preliminary data from the CDC have suggested that, while poor outcomes may be more common among older adults and those with underlying health conditions, young adults are not exempt from this risk. 

References:

1. Du Y, Zhu P, Mu M, et al. Clinical features of 85 fatal cases of COVID-19 from Wuhan: A retrospective observational study. American Journal of Respiratory and Critical Care Medicine. 2020. https://www.atsjournals.org/doi/pdf/10.1164/rccm.202003-0543OC