Clinical and Epidemiological Features of Hospitalized Patients with COVID-19 in Hospitals of Tehran University of Medical Sciences

Abstract

Introduction: Since the start of COVID-19 pandemic in December 2019, until mid-April 2020 the total number of cases worldwide exceeded two millions and the death toll exceeded 130000 cases. Objective: The current study conducted to explore the clinical and epidemiological characteristics of COVID-19 patients, fatality of this disease and its mortality risk factors in major hospitals affiliated with Tehran University of Medical Sciences (TUMS). Methods: The data were collected in four major teaching hospitals affiliated with TUMS for all the patients that were admitted between Feb 19th and Apr 15th 2020 and were diagnosed as COVID-19 using reverse transcription polymerase chain reaction (RT-PCR), clinical diagnosis and/or lung computed tomography (CT) scan. The case fatality rate of the disease was estimated by age, sex, symptoms, comorbidities, and type of diagnosis. Logistic regression model was used to examine the associations between different factors and in-hospital deaths. Results: By Apr 15th 2020, a total of 4377 patients were admitted with COVID-19 diagnosis in four selected hospitals and 496 (11.3%) of these patients died in hospital. The case fatality rate of this disease was 28.8% in the ≥80-year age group, which was the highest compared to the other age groups. The case fatality rates were 12.5% and 9.8% among men and women, respectively. The results of multiple logistic regression on the outcome of death indicated that age, sex, cough, myalgia, reduced consciousness at arrival and past history of cancer were significantly associated with in-hospital death. Adjusting the effect of other variables, for each 10-year increase in age, the odds of death due to COVID-19 was 1.61 times greater (adjusted OR 1.61, 95% CI: 1.51 to 1.72, p<0.001). Conclusions: Older age, the male gender, past history of comorbidities (particularly cancer) and reduced consciousness at arrival are among the factors that can significantly increase the odds of in-hospital death in COVID 19 patients. These factors might be helpful in detecting and managing patients with poorer prognosis.

1. Lu H, Stratton CW, Tang YW. Outbreak of Pneumonia of Unknown Etiology in Wuhan China: the Mystery and the Miracle. J Med Virol. 2020;92(4):401-2.
2. World Health Organization. Coronavirus disease (COVID-19) pandemic. 2020 [cited 2020 15 April]; Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
3. Ahmadi A, Shirani M, Rahmani F. Modeling and Forecasting Trend of COVID-19 Epidemic in Iran. medRxiv. 2020; Preprint.
4. Khosravi A, Chaman R, Rohani-Rasaf M, Zare F, Mehravaran S, Emamian MH. The basic reproduction number and prediction of the epidemic size of the novel coronavirus (COVID-19) in Shahroud, Iran. medRxiv. 2020; Preprint.
5. Dudel C, Riffe T, Acosta E, van Raalte AA, Myrskyla M. Monitoring trends and differences in COVID-19 case fatality rates using decomposition methods: Contributions of age structure and age-specific fatality. medRxiv. 2020; Preprint.
6. Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020;323(18):1775-6.
7. Rajgor DD, Lee MH, Archuleta S, Bagdasarian N, Quek SC. The many estimates of the COVID-19 case fatality rate. Lancet Infect Dis. 2020;20(7):776-7.
8. Worldmeter. COVID-19 CORONAVIRUS PANDEMIC. 2020 [cited 2020 15 April]; Available from: https://www.worldometers.info/coronavirus/?utm_campaign=homeAdvegas1?%20.
9. Sorci G, Faivre B, Morand S. Why does COVID-19 case fatality rate vary among countries? medRxiv. 2020; Preprint.
10. Novel CPERE. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145-51.
11. Statista. Distribution of Coronavirus cases in Italy as of June 3, 2020, by age group. 2020 [cited 2020 15 April]; Health & Pharmaceuticals, State of Health]. Available from: https://www.statista.com/statistics/1103023/coronavirus-cases-distribution-by-age-group-italy/.
12. Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020;395(10239):1763-70.
13. Wang, Kun and Zuo, Pei-yuan and Liu, Yuwei and Zhang, Meng and Zhao, Xiaofang and Xie, Songpu and Zhang, Hao and Chen, Xinglin and Liu, Chengyun, Clinical and Laboratory Predictors of In-Hospital Mortality in 305 Patients with COVID-19: A Cohort Study in Wuhan, China (2/24/2020). Available at SSRN: https://ssrn.com/abstract=3546115 or http://dx.doi.org/10.2139/ssrn.3546115.
14. Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43.
15. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; ;395(10229):1054-62
16. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA. 2020;323(16):1574-81.
17. Wei X, Xiao YT, Wang J, Chen R, Zhang W, Yang Y, et al. Sex differences in severity and mortality among patients with COVID-19: evidence from pooled literature analysis and insights from integrated bioinformatic analysis. arXiv. 2020; Preprint.
18. Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020;55(5):2000524.
19. Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN. Cardiovascular disease, drug therapy, and mortality in Covid-19. N Engl J Med. 2020;382(25):e102.
20. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42.
21. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-5.
22. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-38.
23. Liang W, Liang H, Ou L, Chen B, Chen A, Li C, et al. Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19. JAMA Intern Med. 2020;180(8):1081-9.
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IssueVol 5 No 2 (2021): Spring (April) QRcode
SectionOriginal article
Published2020-12-17
DOI 10.18502/fem.v5i2.5615
Keywords
COVID-19 Epidemiology Hospital Mortality Mortality Odds Ratio

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1.
Baigi V, Nedjat S, Yunesian M, Akbari Sari A, Mirzaee M, Allameh SF. Clinical and Epidemiological Features of Hospitalized Patients with COVID-19 in Hospitals of Tehran University of Medical Sciences. Front Emerg Med. 2020;5(2):e20.

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