Clinical characteristics and risk factors of fatal patients with COVID-19: a retrospective cohort study in Wuhan, China

Jin, Meng; Lu, Zequn; Zhang, Xu; Wang, Yanan; Wang, Jing; Cai, Yimin; Tian, Kunming; Xiong, Zezhong; Zhong, Qiang; Ran, Xiao; Yang, Chunguang; Zeng, Xing; Wang, Lu; Li, Yao; Zhang, Shanshan; Dong, Tianyi; Yue, Xinying; Li, Heng; Liu, Bo; Chen, Xin; Cui, Hongyuan; Qi, Jirong; Fan, Haining; Li, Haixia; Yang, Xiang-Ping; Hu, Zhiquan; Wang, Shaogang; Xiao, Jun; Wang, Ying; Tian, Jianbo; Wang, Zhihua

BACKGROUND: The coronavirus disease 2019 (COVID-19) has caused a global pandemic, resulting in considerable mortality. The risk factors, clinical treatments, especially comprehensive risk models for COVID-19 death are urgently warranted. METHODS: In this retrospective study, 281 non-survivors and 712 survivors with propensity score matching by age, sex, and comorbidities were enrolled from January 13, 2020 to March 31, 2020. RESULTS: Higher SOFA, qSOFA, APACHE II and SIRS scores, hypoxia, elevated inflammatory cytokines, multi-organ dysfunction, decreased immune cell subsets, and complications were significantly associated with the higher COVID-19 death risk. In addition to traditional predictors for death risk, including APACHE II (AUC = 0.83), SIRS (AUC = 0.75), SOFA (AUC = 0.70) and qSOFA scores (AUC = 0.61), another four prediction models that included immune cells subsets (AUC = 0.90), multiple organ damage biomarkers (AUC = 0.89), complications (AUC = 0.88) and inflammatory-related indexes (AUC = 0.75) were established. Additionally, the predictive accuracy of combining these risk factors (AUC = 0.950) was also significantly higher than that of each risk group alone, which was significant for early clinical management for COVID-19. CONCLUSIONS: The potential risk factors could help to predict the clinical prognosis of COVID-19 patients at an early stage. The combined model might be more suitable for the death risk evaluation of COVID-19. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-021-06585-8.