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Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study

Rong-Hui Du, Li-Rong Liang, Cheng-Qing Yang, Wen Wang, Tan-Ze Cao, Ming Li, Guang-Yun Guo, Juan Du, Chun-Lan Zheng, Qi Zhu, Ming Hu, Xu-Yan Li, Peng Peng, Huan-Zhong Shi
European Respiratory Journal 2020 55: 2000524; DOI: 10.1183/13993003.00524-2020
Rong-Hui Du
1Dept of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
3These authors contributed equally
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Li-Rong Liang
2Dept of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
3These authors contributed equally
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Cheng-Qing Yang
1Dept of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
3These authors contributed equally
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Wen Wang
2Dept of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
3These authors contributed equally
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Tan-Ze Cao
1Dept of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
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Ming Li
1Dept of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
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Guang-Yun Guo
1Dept of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
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Juan Du
1Dept of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
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Chun-Lan Zheng
1Dept of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
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Qi Zhu
1Dept of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
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Ming Hu
1Dept of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
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Xu-Yan Li
2Dept of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Peng Peng
1Dept of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
4These authors are joint principal authors
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Huan-Zhong Shi
2Dept of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
4These authors are joint principal authors
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Tables

  • Supplementary Materials
  • TABLE 1

    Demographics and clinical presentation in patients with COVID-19 pneumonia

    CharacteristicsTotalDeceasedSurvivorsp-value
    Patients17921158
    Age years57.6±13.770.2±7.756.0±13.5<0.001
    Sex0.642
     Male97 (54.2)10 (47.6)87 (55.1)
     Female82 (45.8)11 (52.4)71 (44.9)
    Underlying diseases
     Hypertension58 (32.4)13 (61.9)45 (28.5)0.005
     Cardiovascular or cerebrovascular diseases29 (16.2)12 (57.1)17 (10.8)<0.001
     Diabetes33 (18.4)6 (28.6)27 (17.1)0.231
     Chronic digestive disorders21 (11.7)4 (19.0)17 (10.8)0.279
     Tuberculosis8 (4.5)0 (0)8 (5.1)0.599
     Chronic hepatic or renal insufficiency4 (2.2)2 (9.5)2 (1.3)0.068
     Peripheral vascular disease4 (2.2)2 (9.5)2 (1.3)0.068
     Malignancy4 (2.2)1 (4.8)3 (1.9)0.396
    Symptoms
     Fever177 (98.9)21 (100)156 (98.7)1.000
     Dry cough146 (81.6)14 (66.7)132 (83.5)0.074
     Dyspnoea89 (49.7)18 (85.7)71 (44.9)<0.001
     Fatigue71 (39.7)13 (61.9)58 (36.7)0.033
     Sputum production55 (30.7)12 (57.1)43 (27.2)0.010
     Gastrointestinal symptoms39 (21.8)8 (38.1)31 (19.6)0.087
     Myalgia34 (19.0)7 (33.3)27 (17.1)0.083
     Headache17 (9.5)5 (23.8)12 (7.6)0.033
     Haemoptysis10 (5.6)0 (0)10 (6.3)0.609
    Systolic blood pressure mmHgNA122.4±18.6
    Diastolic blood pressure mmHgNA77.9±10.0
    Temperature °C0.156
     <37.3109 (60.9)16 (76.2)93 (58.9)
     ≥37.370 (39.1)5 (23.8)65 (41.1)
    Respiratory rate breaths·min−120.0 (20.0–21.0)20.0 (20.0–34.5)20.0 (20.0–21.0)0.016
    Heart rate beats·min−186.0 (78.0–100)94.0 (78.0–109.5)85.5 (78.0–99.3)0.150

    Data are presented as n, mean±sd, n (%) or median (interquartile range), unless otherwise stated. NA: not available.

    • TABLE 2

      Laboratory findings in patients with COVID-19 pneumonia

      CharacteristicsTotalDeceasedSurvivorsp-value
      Patients17921158
      White blood cells ×109 cells·L−15.3 (3.9–7.8)8.9 (4.8–13.1)5.1 (3.8–7.3)0.003
      Neutrophils ×109 cells·L−14.0 (2.7–6.6)7.7 (3.0–11.5)3.9 (2.6–6.1)0.007
      Lymphocytes ×109 cells·L−10.8 (0.6–1.1)0.7 (0.5–0.8)0.8 (0.6–1.1)0.046
      T-cell subsets
       CD3+CD4+ cells·μL−1114.3 (62.9–195.3)68.0 (55.1–148.8)128.3 (73.5–201.7)0.066
       CD3+CD8+ cells·μL−175.5 (45.5–125.0)47.9 (25.4–73.8)104.5 (58.5–142.7)0.001
      C-reactive protein mg·L−139.8 (20.6–97.8)86.4 (37.9–105.5)36.0 (19.3–91.0)0.012
      Procalcitonin ng·mL−10.1 (0.0–0.2)0.1 (0.1–0.5)0.1 (0.0–0.2)0.013
      Cardiac troponin I ng·mL−10.0 (0.0–0.1)0.1 (0.0–0.8)0.0 (0.0–0.0)<0.001
      Myoglobin ng·mL−136.9 (18.4–124.0)162.0 (48.5–342.8)32.3 (15.5–60.3)<0.001
      Brain natriuretic peptide pg·mL−1645.0 (110.0–1504.0)970.0 (620.5–3531.0)390.0 (58.0–1118.5)0.004
      Albumin g·L−133.2 (30.7–36.4)33.2 (31.2–35.6)33.0 (30.6–38.1)0.764
      Total bilirubin μmol·L−18.9 (6.6–12.5)9.6 (8.3–16.3)8.7 (6.5–12.3)0.146
      Direct bilirubin μmol·L−12.5 (1.8–3.9)3.1 (2.3–6.1)2.4 (1.8–3.8)0.101
      Alanine aminotransferase U·L−122.0 (15.0–40.0)27.0 (20.0–37.0)22.0 (14.0–40.5)0.233
      Aspartate aminotransferase U·L−130.0 (19.0–43.0)40.0 (27.0–61.5)27.5 (19.0–42.0)0.010
      γ-Glutamyltranspeptidase U·L−129.0 (17.0–52.5)23.0 (16.5–42.0)29.0 (17.0–54.5)0.518
      Creatinine μmol·L−166.5 (55.8–82.0)95.0 (63.0–112.0)65.0 (55.0–80.0)0.001
      D-dimer mg·L−10.5 (0.3–1.7)1.1 (0.4–10.5)0.5 (0.3–1.2)0.011
      Prothrombin time s13.7 (12.4–15.4)13.9 (12.3–16.3)13.7 (12.4–15.2)0.758
      Activated partial thromboplastin time s35.6 (31.0–39.4)37.8 (30.8–41.5)35.3 (30.9–39.1)0.383
      PaO2 mmHg72.0 (57.0– 88.0)56.0 (49.0 –71.0)74.5 (59.0–92.0)0.001
      PaCO2 mmHg37.0 (33.0– 41.0)34.0 (29.0–41.0)37.0 (34.0–41.0)0.068
      PaO2:FIO2 mmHg249.6±106.1185.5±64.8261.5±108.20.002

      Data are presented as n, median (interquartile range) or mean±sd, unless otherwise stated. PaO2: arterial oxygen tension; PaCO2: arterial carbon dioxide tension; FIO2: inspiratory oxygen fraction.

      • TABLE 3

        Univariate analysis of mortality risk factors for patients with COVID-19 pneumonia

        CharacteristicsDeceasedSurvivorsOR (95%CI)p-value
        Patients n21158
        Age group years
         0–49031.00.000 (0.000–)0.997
         50–6419.038.62.673 (0.859–8.318)0.090
         ≥6581.030.49.740 (3.113–30.476)<0.001
        Underlying diseases
         Hypertension61.928.54.081 (1.584–10.510)0.004
         Cardiovascular or cerebrovascular diseases57.110.811.059 (4.068–30.063)<0.001
        Symptoms
         Dyspnoea85.744.97.352 (2.082–25.966)0.002
         Fatigue61.936.72.802(1.096–7.160)0.031
         Sputum production57.127.23.566 (1.403–9.061)0.008
         Headache23.87.63.802 (1.187–12.177)0.025
        Respiratory rate >20 breaths·min−147.631.02.022(0.806–5.076)0.134
        White blood cells ×109 cells·L−1
         >1033.312.73.450 (1.242–9.580)0.017
         4–1052.460.11.371 (0.550–3.418)0.499
         <414.327.20.446 (0.125–1.590)0.213
        Neutrophils ×109 cells·L−1
         >6.357.124.74.068 (1.594–10.382)0.003
         1.8–6.333.365.20.267 (0.102–0.700)0.071
         <1.89.510.10.934 (0.199–4.384)0.931
        Lymphocytes <1.1×109 cells·L−190.572.23.667(0.820–16.400)0.089
        CD3+CD8+ T-cells ≤75 cells·μL−178.940.05.625 (1.664–19.013)0.005
        C-reactive protein ≥10 mg·L−195.287.32.901 (0.368–22.878)0.312
        Procalcitonin ≥0.5 ng·mL−121.19.92.438 (0.631–9.414)0.196
        Cardiac troponin I ≥0.05 ng·mL−161.517.97.314 (1.832–29.210)0.005
        Myoglobin >100 ng·mL−164.318.48.000 (2.157–29.671)0.002
        Brain natriuretic peptide >100 pg·mL−194.167.67.680 (0.909–64.906)0.061
        Aspartate aminotransferase >40 U·L−147.629.92.134 (0.848–5.373)0.108
        Creatinine ≥133 μmol·L−119.02.111.137 (2.296–54.028)0.003
        D-dimer ≥0.5 mg·L−176.247.93.474 (1.152–10.481)0.027
        PaO2 mmHg
         ≥8014.341.70.233 (0.065–0.840)0.026
         60–7928.632.40.834 (0.298–2.334)0.730
         <6057.125.93.810 (1.451–10.004)0.007
        PaO2:FIO2 <200 mmHg47.629.22.204 (0.854–5.684)0.102

        Data are presented as %, unless otherwise stated. PaO2: arterial oxygen tension; FIO2: inspiratory oxygen fraction.

        • TABLE 4

          Multivariate logistic regression analysis of mortality risk factors for patients with severe acute respiratory infection

          VariablesOR (95% CI)p-value
          Age ≥65 years3.765 (1.201–11.803)0.023
          Cardiovascular or cerebrovascular diseases2.464 (1.279–4.747)0.007
          CD3+CD8+ T-cells ≤75 cells·μL−13.982 (1.761–9.004)<0.001
          Cardiac troponin I ≥0.05 ng·mL−14.077 (1.778–9.349)<0.001
        • TABLE 5

          Univariate analysis of mortality risk factors for patients with COVID-19 pneumonia in matched case–control study

          VariablesDeceasedSurvivorsOR (95% CI)p-value
          Patients n2142
          CD3+CD8+ T-cells ≤75 cells·μL−178.942.95.000 (1.319–18.960)0.018
          Cardiac troponin I ≥0.05 ng·mL−161.518.27.200 (1.518–34.139)0.013
          Myoglobin >100 ng·mL−160.028.63.750 (0.924–15.226)0.064
          Procalcitonin ≥0.5 ng·mL−121.19.12.667 (0.528–13.477)0.235
          Creatinine ≥133 μmol·L−119.04.84.706 (0.786–28.178)0.090

          Data are presented as %, unless otherwise stated.

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          Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study
          Rong-Hui Du, Li-Rong Liang, Cheng-Qing Yang, Wen Wang, Tan-Ze Cao, Ming Li, Guang-Yun Guo, Juan Du, Chun-Lan Zheng, Qi Zhu, Ming Hu, Xu-Yan Li, Peng Peng, Huan-Zhong Shi
          European Respiratory Journal May 2020, 55 (5) 2000524; DOI: 10.1183/13993003.00524-2020

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          Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study
          Rong-Hui Du, Li-Rong Liang, Cheng-Qing Yang, Wen Wang, Tan-Ze Cao, Ming Li, Guang-Yun Guo, Juan Du, Chun-Lan Zheng, Qi Zhu, Ming Hu, Xu-Yan Li, Peng Peng, Huan-Zhong Shi
          European Respiratory Journal May 2020, 55 (5) 2000524; DOI: 10.1183/13993003.00524-2020
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