tetano
Editor, Senior Moderator
Cureus
. 2022 Nov 7;14(11):e31206.
doi: 10.7759/cureus.31206. eCollection 2022 Nov.
Risk Factors Associated With Six-Month Mortality in Hospitalized COVID-19 Patients: A Single-Institution Study
Navkirat Kahlon[SUP] 1 [/SUP], Jasskiran Kaur[SUP] 2 [/SUP], Sishir Doddi[SUP] 2 [/SUP], Cameron Burmeister[SUP] 2 [/SUP], Taha Sheikh[SUP] 2 [/SUP], Ziad Abuhelwa[SUP] 2 [/SUP], Aya Abugharbyeh[SUP] 3 [/SUP], Ragheb Assaly[SUP] 4 [/SUP], William Barnett[SUP] 5 [/SUP], Danae Hamouda[SUP] 1 [/SUP]
Affiliations
Abstract
Background Coronavirus disease 2019 (COVID-19) infection can vary from asymptomatic infection to multi-organ dysfunction. The most serious complication of infection with COVID-19 is death. Various comorbid conditions and inflammatory markers have been associated with an increased risk of mortality, specifically within the immediate post-infection period; however, less is known about long-term mortality outcomes. Objectives Our objective is to determine risk factors associated with six-month mortality in hospitalized COVID-19 patients. Methods This is a single-institution, retrospective study. We included patients hospitalized with COVID-19 from the University of Toledo Medical Center in Toledo, Ohio, who were admitted from March 20, 2020, to June 30, 2021. This study was approved by a biomedical institutional review board at the University of Toledo. Patients with available pre-stored blood samples for laboratory testing were included, and hospital charts were assessed up to six months from the date of a positive COVID-19 test result. Two groups were created based on the mortality outcome at six months from COVID-19 positive test results: survivors and non-survivors. The clinical variables or outcomes and laboratory values were compared between the two groups using non-parametric methods due to the small sample size and non-normality of the data. Either the Mann-Whitney U-test for continuous variables or Fisher's exact test for categorical variables was used for statistical analysis. Results Lactate dehydrogenase (LDH) and D-dimer levels on admission were found to be significantly higher in non-survivors than in survivors. The median high D-dimer level in non-survivors was 5.96 micrograms/milliliter (μg/mL) (interquartile range (IQR): 3.95-11.29 μg/mL) vs 1.82 μg/mL (IQR 1.13-5.55 μg/mL) in survivors (p = 0.019). Median LDH levels were also higher in non-survivors vs survivors, i.e., 621.00 international units per liter (IU/L) (IQR 440.00-849.00 IU/L) vs 328.00 IU/L (IQR 274.00-529.00 IU/L), respectively (p = 0.032). The demographic profile, comorbidity profile, and laboratory data (typically associated with short-term mortality, inflammation, and organ dysfunction) were similar between survivors and non-survivors, except for LDH and D-dimer. Conclusion Higher LDH and D-dimer levels on admission were found to be associated with an increased six-month mortality rate in hospitalized COVID-19 patients. These hematologic data can serve as risk stratification tools to prevent long-term mortality outcomes and provide proactive clinical care in hospitalized COVID-19 patients.
Keywords: 6-month mortality; covid-19 mortality; elevated d-dimer; elevated ldh; lactate dehydrogenase.
. 2022 Nov 7;14(11):e31206.
doi: 10.7759/cureus.31206. eCollection 2022 Nov.
Risk Factors Associated With Six-Month Mortality in Hospitalized COVID-19 Patients: A Single-Institution Study
Navkirat Kahlon[SUP] 1 [/SUP], Jasskiran Kaur[SUP] 2 [/SUP], Sishir Doddi[SUP] 2 [/SUP], Cameron Burmeister[SUP] 2 [/SUP], Taha Sheikh[SUP] 2 [/SUP], Ziad Abuhelwa[SUP] 2 [/SUP], Aya Abugharbyeh[SUP] 3 [/SUP], Ragheb Assaly[SUP] 4 [/SUP], William Barnett[SUP] 5 [/SUP], Danae Hamouda[SUP] 1 [/SUP]
Affiliations
- PMID: 36505139
- PMCID: PMC9728985
- DOI: 10.7759/cureus.31206
Abstract
Background Coronavirus disease 2019 (COVID-19) infection can vary from asymptomatic infection to multi-organ dysfunction. The most serious complication of infection with COVID-19 is death. Various comorbid conditions and inflammatory markers have been associated with an increased risk of mortality, specifically within the immediate post-infection period; however, less is known about long-term mortality outcomes. Objectives Our objective is to determine risk factors associated with six-month mortality in hospitalized COVID-19 patients. Methods This is a single-institution, retrospective study. We included patients hospitalized with COVID-19 from the University of Toledo Medical Center in Toledo, Ohio, who were admitted from March 20, 2020, to June 30, 2021. This study was approved by a biomedical institutional review board at the University of Toledo. Patients with available pre-stored blood samples for laboratory testing were included, and hospital charts were assessed up to six months from the date of a positive COVID-19 test result. Two groups were created based on the mortality outcome at six months from COVID-19 positive test results: survivors and non-survivors. The clinical variables or outcomes and laboratory values were compared between the two groups using non-parametric methods due to the small sample size and non-normality of the data. Either the Mann-Whitney U-test for continuous variables or Fisher's exact test for categorical variables was used for statistical analysis. Results Lactate dehydrogenase (LDH) and D-dimer levels on admission were found to be significantly higher in non-survivors than in survivors. The median high D-dimer level in non-survivors was 5.96 micrograms/milliliter (μg/mL) (interquartile range (IQR): 3.95-11.29 μg/mL) vs 1.82 μg/mL (IQR 1.13-5.55 μg/mL) in survivors (p = 0.019). Median LDH levels were also higher in non-survivors vs survivors, i.e., 621.00 international units per liter (IU/L) (IQR 440.00-849.00 IU/L) vs 328.00 IU/L (IQR 274.00-529.00 IU/L), respectively (p = 0.032). The demographic profile, comorbidity profile, and laboratory data (typically associated with short-term mortality, inflammation, and organ dysfunction) were similar between survivors and non-survivors, except for LDH and D-dimer. Conclusion Higher LDH and D-dimer levels on admission were found to be associated with an increased six-month mortality rate in hospitalized COVID-19 patients. These hematologic data can serve as risk stratification tools to prevent long-term mortality outcomes and provide proactive clinical care in hospitalized COVID-19 patients.
Keywords: 6-month mortality; covid-19 mortality; elevated d-dimer; elevated ldh; lactate dehydrogenase.