Clinical and laboratory factors determining negative outcomes of inpatients with COVID-19 in the Republic of Mordovia: a retrospective single-center study

Abstract

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, had a profound impact on global health, and society and become one of the deadliest in history. Knowledge of risk factors for mortality is critically important in the formation of organizational, methodological and clinical decisions to limit disease progression and reduce the number of fatal outcomes. However, it is still unclear whether generally accepted risk factors can be equally useful in identifying risk groups in a diverse population of patients in small cities.Aim: To evaluate the utility of demographic, clinical, and laboratory characteristics in the prediction of negative outcome of patients with COVID-19 admitted to the intensive care unit (ICU) of the multidisciplinary COVID-19 hospital in the city of Saransk.Material and Methods. Medical records of 153 patients (including 134 recovered and 19 dead) with laboratory-confirmed SARS-CoV-2 infection treated in the intensive care unit of the S.V. Katkov Republican Clinical Hospital between March and December of 2020 were included in this retrospective, single-center, clinical trial. Demographic, clinical, and laboratory characteristics, complications and therapeutic interventions were compared between deceased and recovered patients. The primary endpoint was in-hospital all-cause mortality. Risk factors for mortality were analyzed using logistic regression.Results. Multivariate regression analysis showed that in the population studied, included both therapeutic and surgical patients, a history of coronary artery disease, chronic non-specific lung disease, acute surgical conditions, plasma creatinine at ICU admission ≥ 106 µmol/L had a negative effect on in-hospital mortality, whereas fever at admission had a protective effect. Patients who died had lower oxygen saturation upon the admission to ICU and were more likely to receive invasive mechanical ventilation and higher doses of dexamethasone in treatment.Conclusion. The present study identified predictors to mortality of patients with COVID-19, treated in the ICU of a Mordovia Republic hospital (Russia), which were somewhat different from those previously reported for larger cities and indicate a large contribution of concomitant diseases to the negative outcome. We did not identify a significant contribution of many proposed laboratory markers to predicting mortality. These findings may help authorities and clinicians optimize organizational, methodological, and clinical approaches to medical care of patients to reduce the risk of a negative outcome from COVID-19.