- Chinese researchers have definitively linked older age, sepsis, elevated d-dimer to mortality in COVID-19 illness.
- Prolonged viral shedding confirms need to isolate infected patients.
Why this matters
- Clinical suspicion is warranted in older patients with higher Sequential Organ Failure Assessment (SOFA) score, elevated d-dimer (>1 µg/L) at admission.
- Consider elevated blood IL-6, high-sensitivity cardiac troponin I, lactate dehydrogenase, lymphopenia as prognostic for severity.
- 191 hospitalized patients, median age 56.0 (interquartile range [IQR], 46.0-67.0) years, 62% male.
- 54 died in-hospital, 137 discharged.
- Median time for illness onset to discharge: 22.0 (IQR, 18-25) days.
- Median time to death: 18.5 (IQR, 15-22) days.
- 48% (91) had comorbidities, most commonly hypertension (30%), diabetes (19%), and coronary heart disease (CHD; 8%).
- Multivariate, higher mortality odds (OR) linked to:
- Older age: 1.10 (P=.0043);
- CHD: 2.14 (P=.48);
- SOFA score: 5.65 (P<.0001>
- Lymphocyte count, 10.0×109/L: 0.19 (P=.13); and
- d-dimer >1 µg/L: 18.42 (P=.0033).
- Median duration of viral shedding among survivors was 20.0 (IQR, 17.0-24.0) days; shedding was detectable until death among nonsurvivors.
- Longest viral shedding duration was 37 days.
- Retrospective, multicenter cohort analysis exploring mortality, clinical course, viral shedding among 2 adult cohorts.
- Funding: Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences.
- Late hospital transfer in some.
- Viral shedding duration estimated.
- Case mortality ratio not reflective of true mortality rates.