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Study identifies risk factors associated with death in adults hospitalised with Coronavirus

Being of an older age, showing signs of sepsis, and having blood clotting issues when admitted to hospital are key risk factors associated with higher risk of death from the new coronavirus (COVID-19), according to a study.

The new study, in The Lancet, is the first-time researchers have examined risk factors associated with severe disease and death in hospitalised adults who have either died or been discharged from hospital.

In the study of 191 patients, 137 were discharged and 54 died in hospital in Wuhan, China.

Specifically, being of an older age, having a high Sequential Organ Failure Assessment (SOFA) score, and having d-dimer greater than 1 μg/mL are the factors that could help clinicians to identify patients with poor prognosis at an early stage.

In addition, the authors present new data on viral shedding, which indicate that the median duration of viral shedding was 20 days in survivors (ranging from 8 to 37 days), and the virus was detectable until death in the 54 non-survivors.

While prolonged viral shedding suggests that patients may still be capable of spreading COVID-19, the authors caution that the duration of viral shedding is influenced by disease severity, and note that all patients in the study were hospitalised, two-thirds of whom had severe or critical illness.

According to co-author Dr Zhibo Liu from Jinyintan Hospital, China: “Older age, showing signs of sepsis on admission, underlying diseases like high blood pressure and diabetes, and the prolonged use of non-invasive ventilation were important factors in the deaths of these patients.

“Poorer outcomes in older people may be due, in part, to the age-related weakening of the immune system and increased inflammation that could promote viral replication and more prolonged responses to inflammation, causing lasting damage to the heart, brain, and other organs.”

For the first time, the study describes the complete picture of the progression of the COVID-19. The median duration of fever was about 12 days in survivors, which was similar in non-survivors.

But the cough may last for a long time—45% of survivors still had cough on discharge. In survivors, dyspnoea (shortness of breath) would cease after about 13 days, but would last until death in non-survivors.

The new analysis includes all adults (aged 18 or older) with laboratory-confirmed COVID-19 admitted to Jinyintan Hospital and Wuhan Pulmonary Hospital after December 29, 2019, who had been discharged or died by January 31, 2020. These were the two designated hospitals for transferring patients with severe COVID-19 from across Wuhan up until February 1, 2020.

On average, patients were middle-aged (median age 56 years), most were men (62%, 119 patients), and around half had underlying chronic conditions (48%, 91 patients)—the most common being high blood pressure (30%, 58 patients) and diabetes (19%, 36 patients; table 1). From illness onset, the median time to discharge was 22 days, and the average time to death was 18.5 days.

Co-lead author Professor Bin Cao from the China-Japan Friendship Hospital and Capital Medical University said the extended viral shedding noted in the study has important implications.

It should guide decisions around isolation precautions and antiviral treatment in patients with confirmed COVID-19 infection.

He said: “We recommend that negative tests for COVID-19 should be required before patients are discharged from hospital. In severe influenza, delayed viral treatment extends how long the virus is shed, and together these factors put infected patients at risk of dying.

“Similarly, effective antiviral treatment may improve outcomes in COVID-19, although we did not observe shortening of viral shedding duration after antiviral treatment in our study.”

Read the full study in The Lancet.

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