Predictors of Mortality for Severe COVID-19: A Descriptive Analysis from an Intensive Care Unit of a Tertiary Care Center
-
Parisa Kianpour
,
Mohammad Hossein Hajali
,
Hamidreza Karbalaei-Musa
,
Reza Mourtami
,
Reza Pourfallah
,
Atabak Najafi
,
Mojtaba Mojtahedzadeh
,
Samrand Fattah Ghazi
,
Arezoo Ahmadi
,
Nasibe Ashouri
,
Babak Jahangirifard
Abstract
Background: This study aimed to investigate mortality risk factors among severe COVID-19 patients admitted to the intensive care unit (ICU) to inform better management strategies and reduce mortality rates.
Methods: A descriptive-analytical, cross-sectional, and retrospective study, was conducted between March 2022 and April 2023 at the intensive care unit of Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. The study included patients admitted to the ICU with severe COVID-19. The main variables were demographic factors (age, gender), pre-existing medical conditions (smoking, diabetes, hypertension), disease severity markers (CT-scan scores, inflammatory and coagulation parameters), and mortality outcomes.
Results: The study included 395 eligible patients. The mortality rate was 57.72%, with no significant difference in hospital stay duration between deceased and survived patients. Smoking, diabetes mellitus, and hypertension were significantly associated with higher mortality. Males exhibited a higher mortality rate, although not statistically significant. Patients over 65 years old had significantly higher mortality. Winter showed a significant increase in mortality, likely due to the Omicron sub-variant. Higher CT-scan scores and elevated inflammatory/coagulation markers correlated with increased mortality risk.
Conclusion: Pre-existing conditions, demographic factors, and disease severity markers are crucial predictors of mortality in severe COVID-19 patients. Tailored interventions targeting these risk factors are essential to improve outcomes.
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[23] Sattar N, McInnes IB, McMurray JJV. Obesity is a risk factor for severe COVID-19 infection: multiple potential mechanisms. Circulation. 2020; 142(1):4-6.
[24] Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring). 2020 Jul; 28(7):1195-1199.
[25] Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28; 395(10229):1054-1062.
[26] Scully EP, Haverfield J, Ursin RL, Tannenbaum C, Klein SL. Considering how biological sex impacts immune responses and COVID-19 outcomes. Nat Rev Immunol. 2020; 20(7):442-447.
[27] Hong KH, Choi JP, Hong SH, Lee J, Kwon JS, Kim SM, et al. Predictors of mortality in Middle East respiratory syndrome (MERS). Thorax. 2018; 73(3):286-289.
[28] Choi KW, Chau TN, Tsang O, Tso E, Chiu MC, Tong WL, et al. Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong. Ann Intern Med. 2003; 139(9):715-723.
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[2] Zhang J, Bishir M, Barbhuiya S, Chang SL. Meta-analysis of the mechanisms underlying COVID-19 modulation of Parkinson’s disease [preprint]. 2023.
[3] Chen R, Charpignon ML, Raquib RV, Wang J, Meza E, Aschmann HE, et al. Excess mortality with Alzheimer disease and related dementias as an underlying or contributing cause during the COVID-19 pandemic in the US. JAMA Neurol. 2023; 80(9):919-928.
[4] Miledi S, Bouzid S, Fazaa A, Sallemi M, Bousaa H, Ben Abdelghani K, et al. COVID-19 in patients with systemic inflammatory diseases: impact on disease activity. Curr Rheumatol Rev. 2023; 19(3):330-335.
[5] Song S, Lee HA, Kim Y, Jeon BK, Moon CM, Park J. Dynamic changing smoking habits and cardiovascular events in patients newly diagnosed with hypertension, diabetes, or dyslipidemia: a national cohort study. Front Cardiovasc Med. 2023; 10:1190227.
[6] Prazeres F, Castro L, Teixeira A. Sociodemographic and clinical determinants of multimorbidity of underlying conditions that increase the risk of severe illness from COVID-19 in chronic adult individuals. BioMed. 2022; 2(1):94-103.
[7] Sow L, Bah MP, N'Famara Bangoura AB, Beavogui Z, Sylla M, Sylla S, et al. Factors associated with mortality in COVID-19 patients with comorbidities who were hospitalized in the different CT-EPI in the Labe region, Guinea 2020-2022. World. 2023; 8(2):139-147.
[8] Abuhelwa Z, Abuhelwa AY, Safi M, Spencer C, Elsamaloty MH, Skeel RT, et al. Risk factors for in-hospital mortality in cancer patients hospitalized for COVID-19. Am Soc Clin Oncol. 2023.
[9] Farhadi N, Varpaei HA, Ghazi SF, Amoozadeh L, Mohammadi M. Deciding when to intubate a COVID-19 patient. Anesthesiol Pain Med. 2022; 12(3).
[10] Al-Tarbsheh A, Chong W, Oweis J, Saha B, Feustel P, Leamon A, et al. Clinical outcomes of early versus late intubation in COVID-19 patients. Cureus. 2022; 14(1):e21669.
[11] Moitra VK, Guerra C, Linde-Zwirble WT, Wunsch H. Relationship between ICU length of stay and long-term mortality for elderly ICU survivors. Crit Care Med. 2016; 44(4):655-662.
[12] Manrique S, Claverias L, Magret M, Masclans JR, Bodi M, Trefler S, et al. Timing of intubation and ICU mortality in COVID-19 patients: a retrospective analysis of 4198 critically ill patients during the first and second waves. BMC Anesthesiol. 2023; 23(1):140.
[13] Kamali A, Chehrei A, Hasanian M, Sofian M, Bahrami M, Khansarinejad B, et al. The extent of lung involvement based on CT-scores, compared to clinical symptoms and laboratory findings in COVID-19 patients. Acta Med Iran. 2023:109-114.
[14] Khodadadi S, Khodakarim N, Kalantari S, Ranjbar Davijani M, Nasri H, Kheiri U. Evaluation of the sensitivity of prominent biomarkers involvement in diagnosing the severity of lung damage in patients with COVID-19. Med J Islam Repub Iran. 2023; 37:14.
[15] Pourbagheri-Sigaroodi A, Bashash D, Fateh F, Abolghasemi H. Laboratory findings in COVID-19 diagnosis and prognosis. Clin Chim Acta. 2020; 510:475-482.
[16] Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology. 2020; 295(3):715-721.
[17] Bhandari S, Rankawat G, Bagarhatta M, Singh A, Singh A, Gupta V, et al. Clinico-radiological evaluation and correlation of CT chest images with progress of disease in COVID-19 patients. J Assoc Physicians India. 2020; 68(7):34-42.
[18] Choi YJ, Park JS, Kim U, Lee SH, Son JW, Shin DG, et al. Changes in smoking behavior and adherence to preventive guidelines among smokers after a heart attack. J Geriatr Cardiol. 2013; 10(2):146.
[19] Dessie ZG, Zewotir T. Mortality-related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423,117 patients. BMC Infect Dis. 2021; 21(1):855.
[20] Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY). 2020; 12(7):6049-6059.
[21] Fadini G, Morieri M, Longato E, Avogaro A. Prevalence and impact of diabetes among people infected with SARS-CoV-2. J Endocrinol Invest. 2020; 43:867-869.
[22] Al-Qudimat AR, Ameen A, Sabir DM, Alkharraz H, Elaarag M, Althani A, et al. The association of hypertension with increased mortality rate during the COVID-19 pandemic: an update with meta-analysis. J Epidemiol Glob Health. 2023; 13(3):495-503.
[23] Sattar N, McInnes IB, McMurray JJV. Obesity is a risk factor for severe COVID-19 infection: multiple potential mechanisms. Circulation. 2020; 142(1):4-6.
[24] Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring). 2020 Jul; 28(7):1195-1199.
[25] Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28; 395(10229):1054-1062.
[26] Scully EP, Haverfield J, Ursin RL, Tannenbaum C, Klein SL. Considering how biological sex impacts immune responses and COVID-19 outcomes. Nat Rev Immunol. 2020; 20(7):442-447.
[27] Hong KH, Choi JP, Hong SH, Lee J, Kwon JS, Kim SM, et al. Predictors of mortality in Middle East respiratory syndrome (MERS). Thorax. 2018; 73(3):286-289.
[28] Choi KW, Chau TN, Tsang O, Tso E, Chiu MC, Tong WL, et al. Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong. Ann Intern Med. 2003; 139(9):715-723.
[29] Majrashi NA, Alhulaibi RA, Nammazi IH, Alqasi MH, Alyami AS, Ageeli WA, et al. A systematic review of the relationship between chest CT severity score and laboratory findings and clinical parameters in COVID-19 pneumonia. Diagnostics (Basel). 2023; 13(13):2223.
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How to Cite
1.
Kianpour P, Hajali MH, Karbalaei-Musa H, Mourtami R, Pourfallah R, Najafi A, Mojtahedzadeh M, Fattah Ghazi S, Ahmadi A, Ashouri N, Jahangirifard B. Predictors of Mortality for Severe COVID-19: A Descriptive Analysis from an Intensive Care Unit of a Tertiary Care Center. Arch Anesth & Crit Care. 2025;.
