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Patient characteristics and prediction of CoViD-19 in-hospital mortality: a retrospective cohort study in Crete, Greece before and after the onset of a targeted vaccination strategy in 2021

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Published: Apr 11, 2023
DOI: https://doi.org/10.12681/healthresj.31249
Keywords:
Covid-19 Greece mortality biomarkers risk stratification
George Makris
Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
Eirini Tzanaki
1st Internal Medicine Department, Venizelion General Hospital, Heraklion, Crete, Greece
Maria Bachlitzanaki
2nd Internal Medicine Department, Venizelion General Hospital, Heraklion, Crete, Greece
Eirini Pasparaki
Respiratory Medicine Department, Venizelion General Hospital, Heraklion, Crete, Greece
Vasilis Amargianitakis
Respiratory Medicine Department, Venizelion General Hospital, Heraklion, Crete, Greece
Androniki Naska
Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens
Vassiliki-Anastasia Sypsa
Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens
Dimitrios Paraskevis
Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens
Abstract

Background: CoviD-19 in-hospital mortality rates show variations across time, setting, patient populations and health-systems.


Aim: The aim of the present study was to explore the association of patient characteristics with in-hospital mortality taking into consideration temporal changes of CoViD-19 prevention and treatment, focusing on the negative predictive value of specific biomarker thresholds for death and oxygen requirements.


Methods: This retrospective study included a sample of 425 vaccine-naive patients hospitalized for CoViD-19 in Crete, Greece. Time-specific mortality rates and negative predictive values of biomarkers on admission were calculated. The association of patient characteristics with mortality was assessed using multivariate logistic regression models.


Results: The overall in hospital case fatality rate (CFR) was 19.53%.  The in-hospital CFR [95% CI] dropped from 22.74% [17.96-27.52] to 11.9% [6.17-17.63] before and after 31/03/2021, as did the mean age of hospitalized patients. LDH & D-dimers ≥240 or ≥0.5), CRP & D-dimers (≥3 or ≥0.5), CRP & Ferritin (≥3 or ≥205) had negative predictive values [95% CI] for mortality of 100% [86.7-100], 96.1% [80.3-99.9] and 95.4% [84.5-99.4] %, but the respective negative predictive values for oxygen requirements were 19.2% [6.5-39.3], 19.2% [6.5-39.3] and 27.2% [14.9-42.7] .


Conclusion: A decreasing trend of in-hospital case fatality rates over the course of our study was associated with a decreasing age of hospitalized patients, which could be associated with community vaccination uptake in people over 60 in Greece through reduction of persons “susceptible” to severe disease. Mortality prediction formulas incorporating biomarkers should be used cautiously for the risk stratification of patients with CoViD-19 in the setting of the emergency department assessment.

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References
Wu, Z. & McGoogan, J. M. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Out-break in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 323, 1239 (2020).
Richardson, S. et al. Presenting Characteristics, Comorbidi-ties, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA 323, 2052–2059 (2020).
Petrilli, C. M. et al. Factors associated with hospital admis-sion and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ m1966 (2020) doi:10.1136/bmj.m1966.
Anesi, G. L. et al. Characteristics, Outcomes, and Trends of Patients With COVID-19–Related Critical Illness at a Learning Health System in the United States. Ann Intern Med 174, 613–621 (2021).
Dennis, J. M., McGovern, A. P., Vollmer, S. J. & Mateen, B. A. Improving Survival of Critical Care Patients With Coronavirus Disease 2019 in England: A National Cohort Study, March to June 2020*. Critical Care Medicine 49, 209–214 (2021).
Horwitz, L. I. et al. Trends in COVID-19 Risk-Adjusted Mor-tality Rates. J Hosp Med 16, 90–92 (2021).
Gray, W. K., Navaratnam, A. V., Day, J., Wendon, J. & Briggs, T. W. R. Changes in COVID-19 in-hospital mortality in hospital-ised adults in England over the first seven months of the pan-demic: An observational study using administrative data. The Lancet Regional Health - Europe 5, 100104 (2021).
Challen, R. et al. Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study. BMJ n579 (2021) doi:10.1136/bmj.n579.
Liang, L.-L., Kuo, H.-S., Ho, H. J. & Wu, C.-Y. COVID-19 vaccinations are associated with reduced fatality rates: Evidence from cross-county quasi-experiments. J Glob Health 11, 05019 (2021).
Bellos, I. et al. Development of a novel risk score for the prediction of critical illness amongst COVID‐19 patients. Int J Clin Pract e13915 (2020) doi:10.1111/ijcp.13915.
Eleni, M. et al. Clinical features and outcomes of hospital-ized COVID-19 patients in a low burden region. Pathog Glob Health 115, 243–249 (2021).
Tzouvelekis, A. et al. Epidemiological characteristics and outcomes from 187 patients with COVID-19 admitted to 6 reference centers in Greece: an observational study during the first wave of the COVID-19 pandemic. Adv Respir Med 89, 378–385 (2021).
Routsi, C. et al. Hospital Resources May Be an Important Aspect of Mortality Rate among Critically Ill Patients with COVID-19: The Paradigm of Greece. J Clin Med 9, 3730 (2020).
Lytras, T. & Tsiodras, S. Total patient load, regional dispari-ties and in-hospital mortality of intubated COVID-19 patients in Greece, from September 2020 to May 2021. Scand J Public Health 14034948211059968 (2021) doi:10.1177/14034948211059968.
CDC. Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/underlying-evidence-table.html (2020).
Del Sole, F. et al. Features of severe COVID-19: A systematic review and meta-analysis. European Journal of Clinical Investi-gation 50, e13378 (2020).
Izcovich, A. et al. Prognostic factors for severity and mortali-ty in patients infected with COVID-19: A systematic review. PLOS ONE 15, e0241955 (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 94, 91–95 (2020).
Kompaniyets, L. Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020–March 2021. Prev. Chronic Dis. 18, (2021).
Azar, K. M. J. et al. Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California. Health Aff (Millwood) 39, 1253–1262 (2020).
Smati, H. et al. Risk Factors for Hospitalization Among Pa-tients with COVID-19 at a Community Ambulatory Clinic in Massachusetts During the Initial Pandemic Surge. J Immigr Minor Health 23, 1110–1115 (2021).
Hayward, S. E. et al. Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income coun-tries: A systematic review. Journal of Migration and Health 3, 100041 (2021).
Wynants, L. et al. Prediction models for diagnosis and prog-nosis of covid-19: systematic review and critical appraisal. BMJ 369, m1328 (2020).
Douillet, D. et al. Outpatient Management of Patients With COVID-19. Chest 160, 1222–1231 (2021).
Information on COVID-19 Treatment, Prevention and Re-search. COVID-19 Treatment Guidelines https://www.covid19treatmentguidelines.nih.gov/.
Data on COVID-19 vaccination in the EU/EEA. European Centre for Disease Prevention and Control https://www.ecdc.europa.eu/en/publications-data/data-covid-19-vaccination-eu-eea (2021).
Data on the daily number of new reported COVID-19 cases and deaths by EU/EEA country. European Centre for Disease Prevention and Control https://www.ecdc.europa.eu/en/publications-data/data-daily-new-cases-covid-19-eueea-country (2021).
Docherty, A. B. et al. Features of 20 133 UK patients in hos-pital with covid-19 using the ISARIC WHO Clinical Characterisa-tion Protocol: prospective observational cohort study. BMJ 369, m1985 (2020).
Siempos, I. I. et al. Effect of Early vs. Delayed or No Intuba-tion on Clinical Outcomes of Patients With COVID-19: An Ob-servational Study. Front Med (Lausanne) 7, 614152 (2020).
Nyberg, T. et al. Comparative analysis of the risks of hospi-talisation and death associated with SARS-CoV-2 omicron (B.1.1.529) and delta (B.1.617.2) variants in England: a cohort study. The Lancet 399, 1303–1312 (2022).
McNamara, L. A. et al. Estimating the early impact of the US COVID-19 vaccination programme on COVID-19 cases, emer-gency department visits, hospital admissions, and deaths among adults aged 65 years and older: an ecological analysis of national surveillance data. The Lancet 399, 152–160 (2022).
Docherty, A. B. et al. Changes in in-hospital mortality in the first wave of COVID-19: a multicentre prospective observational cohort study using the WHO Clinical Characterisation Protocol UK. The Lancet Respiratory Medicine 9, 773–785 (2021).
Data on SARS-CoV-2 variants in the EU/EEA. European Cen-tre for Disease Prevention and Control https://www.ecdc.europa.eu/en/publications-data/data-virus-variants-covid-19-eueea (2021).
Hohl, C. M. et al. The CCEDRRN COVID-19 Mortality Score to predict death among nonpalliative patients with COVID-19 presenting to emergency departments: a derivation and valida-tion study. cmajo 10, E90–E99 (2022).
Mendis, S. et al. Gaps in Capacity in Primary Care in Low-Resource Settings for Implementation of Essential Noncom-municable Disease Interventions. International Journal of Hy-pertension 2012, 1–7 (2012).
Nishtar, S. et al. Time to deliver: report of the WHO Inde-pendent High-Level Commission on NCDs. The Lancet 392, 245–252 (2018).
World Health Organization. Selection of essential in vitro diagnostics at country level: using the WHO model list of es-sential in vitro diagnostics to develop and update a national list of essential in vitro diagnostics. (World Health Organization, 2021).
Miller, J. L. et al. Prediction models for severe manifestations and mortality due to COVID ‐19: A systematic review. Academic Emergency Medicine 29, 206–216 (2022).