Impaired immune and coagulation systems may be early risk factors for COVID-19 patients: A retrospective study of 118 inpatients from Wuhan, China

Qin, Zhi-jun; Liu, Lei; Sun, Qun; Li, Xia; Luo, Jian-fei; Liu, Jia-sheng; Liu, Dan

The coronavirus disease 2019 (COVID-19) outbreak has become a global health threat and will likely be one of the greatest global challenges in the near future. The battle between clinicians and the COVID-19 outbreak may be a “protracted war.” The objective of this study was to investigate the risk factors for in-hospital mortality in patients with COVID-19, so as to provide a reference for the early diagnosis and treatment. This study retrospectively enrolled 118 patients diagnosed with COVID-19, who were admitted to Eastern District of Renmin Hospital of Wuhan University from February 04, 2020 to March 04, 2020. The demographics and laboratory data were collected and compared between survivors and nonsurvivors. The risk factors of in-hospital mortality were explored by univariable and multivariable logistic regression to construct a clinical prediction model, the prediction efficiency of which was verified by receiver-operating characteristic (ROC) curve. A total of 118 patients (49 males and 69 females) were included in this study; the results revealed that the following factors associated with in-hospital mortality: older age (odds ratio [OR] 1.175, 95% confidence interval [CI] 1.073–1.287, P = .001), neutrophil count greater than 6.3 × 10(9) cells/L (OR 7.174, (95% CI 2.295–22.432, P = .001), lymphocytopenia (OR 0.069, 95% CI 0.007–0.722, P = .026), prothrombin time >13 seconds (OR 11.869, 95% CI 1.433–98.278, P = .022), d-dimer >1 mg/L (OR 22.811, 95% CI 2.224–233.910, P = .008) and procalcitonin (PCT) >0.1 ng/mL (OR 23.022, 95% CI 3.108–170.532, P = .002). The area under the ROC curve (AUC) of the above indicators for predicting in-hospital mortality were 0.808 (95% CI 0.715–0.901), 0.809 (95% CI 0.710–0.907), 0.811 (95% CI 0.724–0.898), 0.745 (95% CI 0.643–0.847), 0.872 (95% CI 0.804–0.940), 0.881 (95% CI 0.809–0.953), respectively. The AUC of combined diagnosis of these aforementioned factors were 0.992 (95% CI 0.981–1.000). In conclusion, older age, increased neutrophil count, prothrombin time, d-dimer, PCT, and decreased lymphocyte count at admission were risk factors associated with in-hospital mortality of COVID-19. The prediction model combined of these factors could improve the early identification of mortality risk in COVID-19 patients.