Predictors of severity in coronavirus disease 2019 hospitalized patients

Background
Determination of predictors of coronavirus disease 2019 (COVID-19) severe infection allows early intervention and appropriate treatment of patients at risk, so that we can improve outcome and allow better selection of patients who need hospitalization. Our aim is detection of factors linked to higher rates of complications and death in COVID-19 hospitalized patients.


Results
The study included 151 patients who were divided into mild, moderate, and severe groups; patients with age more than or equal to 60 were more in the severe category (P=0.001). The severe category had considerably more comorbidities (P=0.001). Patients with more than or equal to two comorbidities were more likely to be in the severe category (P=0.006). Obese patients with BMI more than 30 were substantially more likely to be in the severe category (P=0.004). Cough, fever, dyspnea, and vomiting were the most common presentations. Complications of COVID-19 infection were more likely to be detected in the severe category (P=0.001). In the severe category, lymphopenia, raised neutrophil-to-lymphocyte ratio, C-reactive protein, ferritin, lactate dehydrogenase, and D-dimer were all considerably higher. O2 saturation on admission was significantly lower in the severe group with mean (SD) of 81.23 ± 9.22. Duration of admission was significantly longer in the severe group with a range of 9 (3–27) days. Mortality rate in our study was 7.9% (12 cases); all dead cases were included within the severe group.


Conclusion
Physicians should consider patients diagnosed as COVID-19 with high ferritin, elevated neutrophil-to-lymphocyte ratio, lymphopenia, obesity, and high D-dimer as risky for severe infection and need hospitalization with intensive care and proper management to decrease complications, mortality, and for proper triage of COVID-19 patients in hospitals.