Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Type Journal Article Author Fei Zhou Author Ting Yu Author Ronghui Du Author Guohui Fan Author Ying Liu Author Zhibo Liu Author Jie Xiang Author Yeming Wang Author Bin Song Author Xiaoying Gu Author Lulu Guan Author Yuan Wei Author Hui Li Author Xudong Wu Author Jiuyang Xu Author Shengjin Tu Author Yi Zhang Author Hua Chen Author Bin Cao URL https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/abstract Volume 395 Issue 10229 Pages 1054-1062 Publication The Lancet ISSN 0140-6736, 1474-547X Date 11/03/2020 Extra Publisher: Elsevier PMID: 32171076 Journal Abbr The Lancet DOI 10.1016/S0140-6736(20)30566-3 Library Catalog www.thelancet.com Language English Abstract Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Short Title Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China