Impact of Acute Complications on The Course and Outcome of Severe COVID-19: a Clinical Analysis and Determination of Mortality Predictors
Abstract
Aim. To establish the features of the clinical picture, the structure of acute complications and predictors of mortality in patients with a severe course of COVID-19.
Materials and methods. 221 patients who were in the intensive care unit (ICU) of City Clinical Hospital No. 1 in Vinnytsia, Ukraine were examined in the period 2020-2023. Among them, 133 (60.2%) patients survived and 88 (39.8%) of patients died as a result of a severe course of COVID-19 (p = 0.02).
Results. The mortality rate of patients with a severe course of COVID-19 was 39.8%. Among patients classified as categories 6 and 7 by the WHO, the highest mortality was observed, (p<0.001). In the group of deceased patients, there were significantly more patients with hypertension (73 (83.0%) vs. 90 (67.7%), p=0.008), coronary heart disease (CHD) (83 (94.3%) vs. 91 (68.4%)), p = 0.0001), a combination of CAD and hypertension (72 (81.8%) vs. 79 (59.4%), p < 0.001). In addition, acute/chronic kidney diseases (18 (20.5%) vs. 13 (9.8%), p = 0.022) and cancer were more common (12 (13.6%) vs. 8 (6.0%)), p = 0.046).
Among the acute complications that occurred during the stay of patients in the ICU, the deceased patients experienced significantly higher rates of the following conditions: stroke (10 (11.4%) vs. 3 (2.3%), p = 0.006), acute heart failure (9 (10.2%) vs. 4 (3.0%), p = 0.038), pulmonary embolism (9 (10.2%) vs. 3 (2.3%), p = 0.014), infectious toxic shock (10 (11.4%) vs. 1 (0.8%), p = 0.001), acute respiratory distress syndrome (78 (88.6%) vs. 6 (4.5%), p < 0.0001), endstage of renal failure (62 (80.5%) vs. 82 (62.1%), p = 0.006). Additionally, among rhythm disturbances, atrial fibrillation was more prevalent in deceased patients and was associated with a lower survival rate (31 (35.2%) vs. 19 (14.3%), p = 0.0001).
Conclusions. The study demonstrated that clinical factors associated with mortality in patients with a severe course of COVID-19 include patient age and с omorbidity such as hypertension, CAD, heart failure and rhythm disorders. Tachyarrhythmias and bradyarrhythmias were more often observed in deceased patients, in particular, they had more frequent AF, which emphasizes its role as a predictor of poor prognosis in patients with COVID-19.
References
2. Li G, Liu Y, Jing X, Wang Y, Miao M, Tao L, et al. Mortality risk of COVID-19 in elderly males with comorbidities: A multi-country study. Aging. 2020;13(1):27-60. https://doi.org/10.18632/aging.202456
3. Ahmad Malik J, Ahmed S, Shinde M, Almermesh MHS, Alghamdi S, Hussain A, et al. The impact of COVID-19 on comorbidities: A review of recent updates for combating it. Saudi Journal of Biological Sciences. 2022;29(5):3586-3599. https://doi.org/10.1016/j.sjbs.2022.02.00
4. Jiang C, Chen Q, Xie M. Smoking increases the risk of infectious diseases: A narrative review. Tobacco Induced Diseases. 2020;18:60. https://doi.org/10.18332/tid/123845
5. Antinori A, Bausch-Jurken M. The burden of COVID-19 in the immunocompromised patient: Implications for vaccination and needs for the future. Journal of Infectious Diseases. 2023;228(Suppl 1). https://doi.org/10.1093/infdis/jiad181.
6. Gao YD, Ding M, Dong X, Zhang JJ, Kursat Azkur A, Azkur D, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy. 2021;76:428–455. https://doi.org/10.1111/all.14657.
7. Zhao YH, Zhao L, Yang XC, Wang P. Cardiovascular complications of SARS-CoV-2 infection (COVID-19): A systematic review and meta-analysis. Reviews in Cardiovascular Medicine. 2021;22(1):159–165. https://doi.org/10.31083/j.rcm.2021.01.238.
8. Lindner D, Fitzek A, Bräuninger H, Aleshcheva G, Edler C, Meissner K, et al. Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 Autopsy Cases. JAMA Cardiol. 2020;5:1281–1285. https://doi.org/10.1001/jamacardio.2020.355.
9. Kolettis TM. Coronary artery disease and ventricular tachyarrhythmia: pathophysiology and treatment. Curr Op Pharmacol. 2013;13:210–217. https://doi.org/10.1016/j.coph.2013.01.001 .
10. Dherange P, Lang J, Qian P, Oberfeld B, Sauer WH, Koplan B, et al. Arrhythmias and COVID-19: a review. J Am Coll Cardiol EP. 2020;6:1193–1204. https://doi.org/10.1016/j.jacep.2020.08.002 .
11. Varney JA, Dong VS, Tsao T, Sabir MS, Rivera AT, Ghula S, et al. COVID-19 and arrhythmia: An overview. J Cardiol. 2022;79(4):468-475. https://doi.org/10.1016/j.jjcc.2021.11.019.
12. Zadow EK, Wundersitz DWT, Hughes DL, Adams MJ, Kingsley MIC, Blacklock HA, et al. Coronavirus (COVID-19), Coagulation, and Exercise: Interactions That May Influence Health Outcomes. Semin Thromb Hemost. 2020;46(7):807-814. https://doi.org/10.1055/s-0040-1715094 .
13. De Carvalho H, Richard MC, Chouihed T, Goffinet N, Le Bastard Q, Freund Y, et al. Electrolyte imbalance in COVID-19 patients admitted to the Emergency Department: a case-control study. Intern Emerg Med. 2021;16(7):1945-1950. https://doi.org/10.1007/s11739-021-02632-z .
14. Wu CI, Postema PG, Arbelo E, Behr ER, Bezzina CR, Napolitano C, et al. SARS-CoV-2, COVID-19, and inherited arrhythmia syndromes. Heart Rhythm. 2020;17:1456– 1462. https://doi.org/10.1016/j.hrthm.2020.03.024 .
15. Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the Treatment of Covid-19 – Final Report. N Engl J Med. 2020; 383 (19): 1813-1826. https://doi.org/10.1056/NEJMoa2007764 .
16. IBM Corp. IBM SPSS Statistics Core System User’s Guide, Version 28.0. IBM Documentation; 2021. Available from: https://www.ibm.com/docs/en/SSLVMB_28.0.0/pdf/ru/IBM_SPSS_Statistics_Core_System_User_Guide.pdf.
17. Taylor EH, Marson EJ, Elhadi M, Macleod KDM, Yu YC, Davids R, et al. Factors associated with mortality in patients with COVID-19 admitted to intensive care: a systematic review and meta-analysis. Anaesthesia. 2021;76(9):1224-1232. https://doi.org/10.1111/anae.15532 .
18. Del Sole F, Farcomeni A, Loffredo L, Carnevale R, Menichelli D, Vicario T, et al. Features of severe COVID-19: A systematic review and meta-analysis. Eur J Clin Invest. 2020;50(10):e13378. https://doi.org/10.1111/eci.13378 .
19. Plasencia-Urizarri TM, Aguilera-Rodríguez R, Almaguer-Mederos LE. Comorbidities and clinical severity of COVID-19: systematic review and meta-analysis. Revista Habanera de Ciencias Médicas. 2020;19(Suppl: 1):1-18.
20. Chen Z, Peng Y, Wu X, Pang B, Yang F, Zheng W, et al. Comorbidities and complications of COVID-19 associated with disease severity, progression, and mortality in China with centralized isolation and hospitalization: A systematic review and meta-analysis. Front Public Health. 2022;16(10):923485. https://doi.org/10.3389/fpubh.2022.923485 .
21. Wen W, Zhang H, Zhou M, Cheng Y, Ye L, Chen J, et al. Arrhythmia in patients with severe coronavirus disease (COVID-19): a meta-analysis. Eur Rev Med Pharmacol Sci. 2020;24(21):11395-11401. https://doi.org/10.26355/eurrev_202011_23632.
