Baseline Characteristics and Associated Factors of Mortality in COVID-19 Patients; an Analysis of 16000 Cases in Tehran, Iran
Archives of Academic Emergency Medicine,
Vol. 8 No. 1 (2020),
7 January 2020
Introduction: Given the importance of evidence-based decision-making, this study aimed to evaluate epidemiological and clinical characteristics as well as associate factors of mortality among admitted COVID-19 cases.
Methods: This multicenter, cross-sectional study was conducted on confirmed and suspected COVID-19 cases who were hospitalized in 19 public hospitals affiliated to Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran, between February 19 and May 12, 2020. Epidemiological and clinical characteristics of the infected cases were compared between the deceased and survivors after discharge. Case fatality rates (CFRs) were calculated across all study variables. Single and multiple logistic regressions were used to explore the risk factors associated with COIVD-19 mortality.
Results: Out of the 16035 cases that referred to the hospitals affiliated to SBMU, 16016 patients (99.93% of Confirmed and 99.83% of suspected cases) were hospitalized. 1612 patients died with median hospitalization days of 5 (interquartile range (IQR): 2-9) and 3 (1-7) for confirmed and suspected COVID-19 cases, respectively. The highest death rate was observed among ages>65 (63.4% of confirmed cases, 62.3% of suspected cases) and intensive care unit (ICU)/critical care unit (CCU) patients (62.7% of confirmed cases, 52.2% of suspected cases). Total case fatality rate (CFR) was 10.05% (13.52% and 6.37% among confirmed and suspected cases, respectively). The highest total CFR was observed in patients with age>65 years (25.32%), underlying comorbidities (25.55%), and ICU/CCU patients (41.7%). The highest CFR was reported for patients who had diabetes and cardiovascular diseases (38.46%) as underlying non-communicable diseases (NCDs), and patients with cancer (35.79%).
Conclusion: This study showed a high CFR among suspected and confirmed COVID-19 cases, and highlighted the main associated risk factors including age, sex, underlying NCDs, and ICU/CCU admission affecting survival of COVID-19 patients.
- COVID-19; Inpatients; Survival; Mortality; Comorbidity; Noncommunicable Diseases; Iran
How to Cite
Cucinotta, D. and M. Vanelli, WHO declares COVID-19 a pandemic. Acta bio-medica: Atenei Parmensis, 2020. 91(1): p. 157-160.
Organization, W.H. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. March 11, 2020]; Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.
Khachfe, H.H., et al., An epidemiological study on COVID-19: a rapidly spreading disease. Cureus, 2020. 12(3).
Moradian, N., et al., The urgent need for integrated science to fight COVID-19 pandemic and beyond. Journal of Translational Medicine, 2020. 18(1): p. 1-7.
Worldometer. COVID-19 CORONAVIRUS PANDEMIC. May 27 ,2020]; Available from: https://www.worldometers.info/coronavirus/.
Shankar, A., et al., Cancer care delivery challenges amidst coronavirus disease–19 (COVID-19) outbreak: specific precautions for cancer patients and cancer care providers to prevent spread. Asian Pacific Journal of Cancer Prevention, 2020. 21(3): p. 569-573.
Takian, A., A. Raoofi, and S. Kazempour-Ardebili, COVID-19 battle during the toughest sanctions against Iran. Lancet (London, England), 2020. 395(10229): p. 1035.
Center, J.H.C.R., COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University
Ssentongo, P., et al., The association of cardiovascular disease and other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis. medRxiv, 2020: p. 2020.05.10.20097253.
Zhou, F., 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.
Yang, J., et al., Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. International Journal of Infectious Diseases, 2020. 94: p. 91-95.
Pal, R. and A. Bhansali, COVID-19, diabetes mellitus and ACE2: the conundrum. diabetes research and clinical practice, 2020. 162.
Spychalski, P., A. Błażyńska-Spychalska, and J. Kobiela, Estimating case fatality rates of COVID-19. The Lancet Infectious Diseases, 2020.
Modi, C., et al., How deadly is COVID-19? A rigorous analysis of excess mortality and age-dependent fatality rates in Italy. medRxiv, 2020: p. 2020.04.15.20067074.
Rajgor, D.D., et al., The many estimates of the COVID-19 case fatality rate. The Lancet Infectious Diseases, 2020.
Moradi, G., et al., Can judgments according to case fatality rate be correct all the time during epidemics? Estimated cases based on CFR in different scenarios and some lessons from early case fatality rate of coronavirus disease 2019 in Iran. Medical Journal of The Islamic Republic of Iran (MJIRI), 2020. 34(1): p. 178-182.
Lippi, G., et al., Clinical and demographic characteristics of patients dying from COVID-19 in Italy versus China. Journal of Medical Virology. n/a(n/a).
Covid, C., et al., Coronavirus Disease 2019 in Children—United States, February 12–April 2, 2020. Morbidity and Mortality Weekly Report, 2020. 69(14): p. 422.
Huang, C., et al., Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 2020. 395(10223): p. 497-506.
Chen, N., et al., Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet, 2020. 395(10223): p. 507-513.
Wang, D., et al., Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama, 2020. 323(11): p. 1061-1069.
Wu, C., et al., Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA internal medicine, 2020.
Nikpouraghdam, M., et al., Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study. Journal of Clinical Virology, 2020.
Emami, A., et al., Characteristics of deceased patients with CoVID-19 after the first peak of the epidemic in Fars province, Iran. Infection Ecology & Epidemiology, 2020. 10(1): p. 1781330.
Masoud, N.-V., et al., Clinical Characteristics of Fatal Cases of COVID-19 in Tabriz, Iran: An Analysis of 111 Patients. Advanced Journal of Emergency Medicine, 2020. 0(0).
Shahriarirad, R., et al., Epidemiological and clinical features of 2019 novel coronavirus diseases (COVID-19) in the South of Iran. BMC Infectious Diseases, 2020. 20(1): p. 427.
Rebecca A. Harrington Case fatality rate. 2020.
Li, X., et al., Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. Journal of Allergy and Clinical Immunology, 2020.
Tian, J., et al., Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study. The Lancet Oncology.
Sun, H., et al., Risk Factors for Mortality in 244 Older Adults With COVID-19 in Wuhan, China: A Retrospective Study. J Am Geriatr Soc, 2020.
Zheng, Z., et al., Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. Journal of Infection, 2020.
Michelozzi, P., et al., Mortality impacts of the coronavirus disease (COVID-19) outbreak by sex and age: rapid mortality surveillance system, Italy, 1 February to 18 April 2020. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, 2020. 25(19): p. 2000620.
Yi, Y., et al., COVID-19: what has been learned and to be learned about the novel coronavirus disease. International journal of biological sciences, 2020. 16(10): p. 1753-1766.
Guan, W.-J., et al., Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. The European respiratory journal, 2020. 55(5): p. 2000547.
Wang, B., et al., Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY), 2020. 12(7): p. 6049-6057.
National Committee on COVID Epidemiology and Iranian CDC, Daily Situation Report on Coronavirus disease (COVID-19) in Iran; May 12, 2020. 2020, Ministry of Health and Medical Education: Tehran, Iran.
National Committee on COVID Epidemiology and Iranian CDC, Daily Situation Report on Coronavirus disease (COVID-19) in Iran; May 5, 2020. 2020, Ministry of Health and Medical Education: Tehran, Iran.
Li, H., et al., Age-Dependent Risks of Incidence and Mortality of COVID-19 in Hubei Province and Other Parts of China. Frontiers in medicine, 2020. 7: p. 190-190.
[The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi, 2020. 41(2): p. 145-151.
Richardson, S., et al., Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA, 2020. 323(20): p. 2052-2059.
Cases-Hospitalizations-Deaths. COVID-19: Data Summary - NYC Health. 2020 [Accessed June 9]]; Available from: https://www1.nyc.gov/site/doh/covid/covid-19-data.page.
Jalili, M., et al., Characteristics and Mortality of Hospitalized Patients With COVID-19 in Iran: A National Retrospective Cohort Study. Annals of Internal Medicine, 2020.
Quah, P., A. Li, and J. Phua, Mortality rates of patients with COVID-19 in the intensive care unit: a systematic review of the emerging literature. Critical care (London, England), 2020. 24(1): p. 285-285.
wang, z., et al., Survival analysis of hospital length of stay of novel coronavirus (COVID-19) pneumonia patients in Sichuan, China. medRxiv, 2020: p. 2020.04.07.20057299.
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