Analysis of death risk factors among COVID-19 patients in Yazd, Iran: a hospital-based case-cohort study
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Keywords

COVID-19; Iran, Case-cohort study; Risk factors; Mortality, SARS-CoV-2

Abstract

Introduction: The COVID-19 epidemic control has become a global challenge and many contributing variables are still unknown to policymakers. This case-cohort study was conducted to investigate the risk factors of mortality in COVID-19 patients.

Materials and Methods: This case-cohort study was conducted on 956 samples in Ardakan and Meybod counties, Yazd Province, between February 20 and May 20, 2020. Data analysis was done using descriptive statistics and paired t-test, chi-square, and logistic regression analysis.

Results: Of a total cohort population of 993 in Ardakan and Meybod counties, 435 were assigned to the control group and 521 were assigned to the case group. The results of outcome analysis showed that 14.4% of the patients in the case group and 11.5% of the patients in the control group died. According to the results of logistic regression analysis in COVID-19 patients, each one-year increase in age increased the risk of mortality by 6% (HR=1.06, p<0.001), each one-day increase in the hospital stay increased the risk of death by 8% (HR=1.08, p<0.001). Moreover, the presence of cardiovascular disease, chronic neurological disease, and chronic pulmonary disease increased the risk of death. The patients who underwent mechanical ventilation had 85% less chance of survival (HR=0.15, p<0.001).

Conclusion: The results showed a higher mortality rate in the elderly patients as well as those with underlying diseases. Attention should be paid to at-risk and elderly patients in terms of ensuring a healthy diet, improving their self-care practices, and providing long-term medical and healthcare facilities.

https://doi.org/10.15167/2421-4248/jpmh2023.64.3.3098
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References

Paraskevis D, Kostaki EG, Magiorkinis G, Panayiotakopoulos G, Sourvinos G, Tsiodras S. Full-genome evolutionary analysis of the novel corona virus (2019-nCoV) rejects the hypothesis of emergence as a result of a recent recombination event. Infection, Genetics and Evolution. 2020; 79:104212. doi: 10.1016/j.meegid.2020.104212. Epub 2020 Jan 29.

World Health Organization. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV); 2005. [cited 2020 Jan 30] Available from: https://www.who.int/newsroom/detail/30-01-2020-statement-on-the-secondmeeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-ofnovel-coronavirus-(2019-ncov).

Gralinski LE, Menachery VD. Return of the Coronavirus: 2019-nCoV. Viruses. 2020;12(2):135. doi: 10.3390/v12020135.

Xu K, Lai X, Liu Z. Suggestions for prevention of 2019 novel coronavirus infection in otolaryngology head and neck surgery medical staff. Zhonghua er bi yan hou tou jing wai ke za zhi= Chinese journal of otorhinolaryngology head and neck surgery. 2020;55:E001. doi: 10.3760/cma.j.issn.1673-0860.2020.0001.

Alshahrani MS, Sindi A, Alshamsi F, Al-Omari A, El Tahan M, Alahmadi B, et al. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Annals of intensive care. 2018;8(1):3. doi: 10.1186/s13613-017-0350-x.

Arabi YM, Alothman A, Balkhy HH, Al-Dawood A, AlJohani S, Al Harbi S, et al. Treatment of Middle East Respiratory Syndrome with a combination of lopinavir-ritonavir and interferon-β1b (MIRACLE trial): study protocol for a randomized controlled trial. Trials. 2018;19(1):81. doi: 10.1186/s13063-017-2427-0.

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 : the journal of the American Medical Association. 2020.

doi: 10.1001/jama.2020.2648.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Annals of internal medicine. 2007;147(8):573-7. doi: 10.1016/j.ijsu.2014.07.013.

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. The lancet. 2020.

doi: 10.1016/S0140-6736(20)30566-3.

Shi Q, Zhang X, Jiang F, Zhang X, Hu N, Bimu C, et al. Clinical characteristics and risk factors for mortality of COVID-19 patients with diabetes in Wuhan, China: a two-center, retrospective study. Diabetes Care. 2020. DOI: 10.2337/dc20-0598

Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. Journal of Infection. 2020. DOI: 10.1016/j.jinf.2020.03.005

Covid C, Team R. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):343-6.

China C. Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. Vital surveillance: The epidemiological characteristics of an outbreak of. 2019.

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. DOI: 10.1001/jama.2020.2648

Zhang J, Wang X, Jia X, Li J, Hu K, Chen G, et al. Risk factors for disease severity, unimprovement, and mortality of COVID-19 patients in Wuhan, China. Clinical Microbiology and Infection. 2020. DOI: 10.1016/j.cmi.2020.04.012

Thai PQ, Dinh TS, Van Hoang TH, Luu NM, Hung LX, Luu NH, et al. Factors associated with the duration of hospitalization among COVID-19 patients in Vietnam: A survival analysis. Epidemiology & Infection. 2020:1-20. DOI: 10.1017/S0950268820001259

CDC (Centers for Disease Control and Prevention) (2020) Severe outcomes among patients with coronavirus disease 2019 (COVID-19) –United States, February 12–March 16, 2020. MMWR. Morbidity and Mortality Weekly Report 69, 343–346. Available at https://www.cdc.gov/ mmwr/volumes/69/wr/mm6912e2.htm.

Lescure F-X, Bouadma L, Nguyen D, Parisey M, Wicky P-H, Behillil S, et al. Clinical and virological data of the first cases of COVID-19 in Europe: a case series. The Lancet Infectious Diseases. 2020. doi: 10.1016/S1473-3099(20)30200-0.

Wise J. A third of covid-19 patients admitted to UK hospitals die. British Medical Journal Publishing Group; 2020. DOI: 10.1136/bmj.m1794

Taylor E, Hofmeyr R, Torborg A, van Tonder C, Boden R, Earle E, et al. Risk factors and interventions associated with mortality or survival in adult COVID-19 patients admitted to critical care: a systematic review and meta-analysis. Southern African Journal of Anaesthesia and Analgesia. 2020;26(3):116-27.

Ma J, Xia P, Zhou Y, Liu Z, Zhou X, Wang J, et al. Potential effect of blood purification therapy in reducing cytokine storm as a late complication of critically ill COVID-19. Clinical Immunology (Orlando, Fla). 2020;214:108408. doi: 10.1016/j.clim.2020.108408. Epub 2020 Apr 1.

Pan C, Chen L, Lu C, Zhang W, Xia J-A, Sklar MC, et al. Lung Recruitability in COVID-19–associated Acute Respiratory Distress Syndrome: A Single-Center Observational Study. American journal of respiratory and critical care medicine. 2020;201(10):1294-7. doi: 10.1164/rccm.202003-0527LE.

Ren L-L, Wang Y-M, Wu Z-Q, Xiang Z-C, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chinese medical journal. 2020. doi: 10.1097/CM9.0000000000000722.

Grasselli G, Greco M, Zanella A, Albano G, et al. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med. 2020 Oct 1;180(10):1345-1355. doi: 10.1001/jamainternmed.2020.3539.

Pengqiang Du, Dandan Li, Aifeng Wang, Su Shen. A Systematic Review and Meta-Analysis of Risk Factors Associated with Severity and Death in COVID-19 Patients. Can J Infect Dis Med Microbiol. 2021 Apr 10;2021:6660930. doi: 10.1155/2021/6660930.

Mehri A, Sotoodeh Ghorbani S, Farhadi-Babadi K, Rahimi E, Barati Z. Risk Factors Associated with Severity and Death from COVID-19 in Iran: A Systematic Review and Meta-Analysis Study. J Intensive Care Med. 2023 Sep;38(9):825-837. doi: 10.1177/08850666231166344.