Investigation of all-cause mortality and associated factors in patients diagnosed with COVID-19: A Retrospective Cohort Study

Yıl 2023, Cilt: 21 Sayı: 3, 336 - 348, 15.12.2023

Ahmet Furkan Süner , Ahmet Naci Emecen , Salih Keskin , Neslişah Şiyve , Ecem Başoğlu Şensoy , Öykü Turunç , Belgin Ünal

https://doi.org/10.20518/tjph.1293201

Cited By: 1

Öz

Objective: This study aims to investigate the extent and associated factors of all-cause mortality in patients diagnosed with COVID-19 in a hospital for over a one-year follow-up period.

Methods: This retrospective cohort study was conducted on the patients who applied and tested positive for SARS-CoV-2 in the Dokuz Eylul University Hospital which is a large tertiary healthcare facility in Izmir, Turkey, between 19.03.2020 and 31.05.2021. The study included 8955 adult patients with a positive SARS-CoV-2 PCR test. Kaplan-Meier survival analysis and Cox regression models were used to examine the relationships between demographic and clinical characteristics and mortality.

Results: The cumulative all-cause mortality rate was 4.7% in COVID-19 patients. Patients over 80 years old had a significantly higher risk of death compared to those younger than 50 years old (aHR:22.3; 95% CI: 10.4-47.7). Current or ex-smokers had a higher risk of death compared to non-smokers (aHR: 1.6; 95% CI: 1.1-2.4). Patients without any complaints before diagnosis had a higher risk of death compared to those with three or more complaints (aHR: 1.7; 95% CI: 1.2-2.6). Patients hospitalized in the intensive care unit had a significantly higher risk of death compared to outpatients (aHR: 62.3; 95% CI: 37.6-101.9).

Conclusions: In COVID-19 patients, the risk of all-cause mortality is higher in the elderly, smokers, individuals admitted to medical or intensive care services, and those with a decreasing number of pre-diagnostic complaints. Monitoring patients with long follow-up periods and determining the course of illness and cause of death are important for understanding the natural course of COVID-19.

Anahtar Kelimeler

COVID-19, mortality, Follow-Up Study

Destekleyen Kurum

There is no Supporting Institution.

Proje Numarası

The study was not carried out within the scope of the project.

Kaynakça

• WHO. Coronavirus (COVID-19) Dashboard. Published October 8, 2023. Accessed October 8, 2022. https://covid19.who.int
• Natasha H, Egbert S, Annemarie TV. Conflict And Health. McGraw-Hill Education (UK); 2012.
• Karlinsky A, Kobak D. Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset. eLife. 2021;10:e69336. doi:10.7554/eLife.69336
• Alharthy A, Aletreby W, Faqihi F, et al. Clinical characteristics and predictors of 28-day mortality in 352 critically ill patients with COVID-19: a retrospective study. J Epidemiol Glob Health. 2021;11(1):98.
• Wang S, Ma P, Zhang S, et al. Fasting blood glucose at admission is an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes: a multi-centre retrospective study. Diabetologia. 2020;63(10):2102-2111.
• Ioannidis JPA. Infection fatality rate of COVID-19 inferred from seroprevalence data. Bull World Health Organ. 2021;99(1):19-33F. doi:10.2471/BLT.20.265892
• WHO. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 3 March 2020. Published March 3, 2020. Accessed May 19, 2022. https://www.who.int/director-general/speeches/detail/who-director-general-s-openingremarks-at-the-media-briefing-on-covid-19---3-march-2020
• Verduri A, Short R, Carter B, et al. Comparison between first and second wave of COVID-19 outbreak in older people. The COPE multicentre European observational cohort study. Eur J Public Health. Published online August 23, 2022:ckac108. doi:10.1093/eurpub/ckac108
• Ferguson N, Laydon D, Nedjati Gilani G, et al. Report 9: Impact of Non-Pharmaceutical Interventions (NPIs) to Reduce COVID19 Mortality and Healthcare Demand. Imperial College London; 2020. doi:10.25561/77482
• Woorim K, Ji Min H, Kyung. Predictors of Mortality in Patients with COVID-19: A Systematic Review and Meta-analysis. 2020;30(3):169-176.
• Aldridge RW, Lewer D, Katikireddi SV, et al. Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data. Wellcome Open Res. 2020;5:88. doi:10.12688/wellcomeopenres.15922.2
• Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985. doi:10.1136/bmj.m1985
• Zuin M, Rigatelli G, Zuliani G, Rigatelli A, Mazza A, Roncon L. Arterial hypertension and risk of death in patients with COVID-19 infection: Systematic review and meta-analysis. J Infect. 2020;81(1):e84-e86. doi:10.1016/j.jinf.2020.03.059
• Chen R, Liang W, Jiang M, et al. Risk Factors of Fatal Outcome in Hospitalized Subjects With Coronavirus Disease 2019 From a Nationwide Analysis in China. Chest. 2020;158(1):97-105. doi:10.1016/j.chest.2020.04.010
• Elliott J, Bodinier B, Whitaker M, et al. COVID-19 mortality in the UK Biobank cohort: revisiting and evaluating risk factors. Eur J Epidemiol. 2021;36(3):299-309. doi:10.1007/s10654-021-00722-y
• Henry BM, Lippi G. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. Int Urol Nephrol. 2020;52(6):1193-1194. doi:10.1007/s11255-020-02451-9
• Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract. 2020;162:108142. doi:10.1016/j.diabres.2020.108142
• Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020;108:154262. doi:10.1016/j.metabol.2020.154262
• Vardavas CI, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis. 2020;18:20. doi:10.18332/tid/119324
• Hastie CE, Mackay DF, Ho F, et al. Vitamin D concentrations and COVID-19 infection in UK Biobank. Diabetes Metab Syndr. 2020;14(4):561-Suner AF., et al. Turk J Public Health 2023;21(3) 347 565. doi:10.1016/j.dsx.2020.04.050
• Ilie PC, Stefanescu S, Smith L. The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality. Aging Clin Exp Res. 2020;32(7):1195-1198. doi:10.1007/s40520-020-01570-8
• Martelletti L, Martelletti P. Air Pollution and the Novel Covid-19 Disease: a Putative Disease Risk Factor. SN Compr Clin Med. 2020;2(4):383-387. doi:10.1007/s42399-020-00274-4
• Ünal B. Dokuz Eylul University hospital COVID-19 follow-up center: Performance and preliminary findings. Journal of Dokuz Eylul University Medical Faculty. 2021;35(3):343-350.
• Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966. doi:10.1136/bmj.m1966
• Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3
• Mahendra M, Nuchin A, Kumar R, Shreedhar S, Mahesh PA. Predictors of mortality in patients with severe COVID-19 pneumonia - a retrospective study. Adv Respir Med. 2021;89(2):135-144. doi:10.5603/ARM.a2021.0036
• Kang SJ, Jung SI. Age-Related Morbidity and Mortality among Patients with COVID-19. Infect Chemother. 2020;52(2):154-164. doi:10.3947/ic.2020.52.2.154
• Galbadage T, Peterson BM, Awada J, et al. Systematic review and meta-analysis of sex-specific COVID-19 clinical outcomes. Front Med. 2020;7:348.
• Salinas-Escudero G, Carrillo-Vega MF, Granados- García V, Martínez-Valverde S, Toledano-Toledano F, Garduno-Espinosa J. A survival analysis of COVID-19 in the Mexican population. BMC Public Health. 2020;20(1):1-8.
• Alguwaihes AM, Al-Sofiani ME, Megdad M, et al. Diabetes and Covid-19 among hospitalized patients in Saudi Arabia: a single-centre retrospective study. Cardiovasc Diabetol. 2020;19(1):1-12.
• Imai Y, Kuba K, Penninger JM. The discovery of angiotensin-converting enzyme 2 and its role in acute lung injury in mice. Exp Physiol. 2008;93(5):543-548.
• Kreutz R, Algharably EAEH, Azizi M, et al. Hypertension, the renin–angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19: European Society of Hypertension COVID-19 Task Force Review of Evidence. Cardiovasc Res. 2020;116(10):1688-1699.
• Li C, Chen Q, Wang J, et al. Clinical characteristics of chronic liver disease with coronavirus disease 2019 (COVID-19): a cohort study in Wuhan, China. Aging. 2020;12(16):15938.
• Balkissoon R. Journal Club—Severe Acute Respiratory Syndrome Coronavirus-2: Impact on COPD Patients. Chronic Obstr Pulm Dis J COPD Found. 2020;7(4):413.
• Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet Lond Engl. 2020;395(10224):565-574. doi:10.1016/S0140-6736(20)30251-8
• Matsumoto K, Saito H. Does asthma affect morbidity or severity of COVID-19? J Allergy Clin Immunol. 2020;146(1):55-57.
• 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):1239-1242. doi:10.1001/jama.2020.2648
• Finelli L, Gupta V, Petigara T, Yu K, Bauer KA, Puzniak LA. Mortality Among US Patients Hospitalized With SARS-CoV-2 Infection in 2020. JAMA Netw Open. 2021;4(4):e216556. doi:10.1001/jamanetworkopen.2021.6556
• Alwafi H, Naser AY, Qanash S, et al. Predictors of Length of Hospital Stay, Mortality, and Outcomes Among Hospitalised COVID-19 Patients in Saudi Arabia: A Cross-Sectional Study. J Multidiscip Healthc. 2021;14:839-852. doi:10.2147/JMDH. S304788
• Zareifopoulos N, Lagadinou M, Karela A, Platanaki C, Karantzogiannis G, Velissaris D. Management of COVID-19: the risks associated with treatment are clear, but the benefits remain uncertain. Monaldi 348 Investigation of all-cause mortality Turk J Public Health 2023;21(3) Arch Chest Dis. 2020;90(2).
• Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect. 2020;81(2):e16-e25. doi:10.1016/j. jinf.2020.04.021