Risk factors associated with mortality in COVID-19 patients with pulmonary involvement in Behbahan County, Southwestern Iran

Touba  Narimani Moghadam; Vahid  Rajab Nezhadi; Soroush  Ardeshiri; Alireza  Ahmadi; Aida  Pajoohesh; Jaffar  Fatahi Asl

doi:10.66224/jcbior.7.3.364

Authors

Touba Narimani Moghadam Department of Public Health, Behbahan Faculty of Medical Sciences, Behbahan, Iran https://orcid.org/0000-0002-5482-3059
Vahid Rajab Nezhadi Student Research and Technology Committee, Behbahan Faculty of Medical Sciences, Behbahan, Iran https://orcid.org/0000-0002-5247-9848
Soroush Ardeshiri Student Research and Technology Committee, Behbahan Faculty of Medical Sciences, Behbahan, Iran https://orcid.org/0000-0002-9339-7005
Alireza Ahmadi Student Research and Technology Committee, Behbahan Faculty of Medical Sciences, Behbahan, Iran https://orcid.org/0000-0003-4601-1293
Aida Pajoohesh Student Research and Technology Committee, Behbahan Faculty of Medical Sciences, Behbahan, Iran https://orcid.org/0000-0002-1841-9067
Jaffar Fatahi Asl Department of Radiologic Technology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran https://orcid.org/0000-0002-3301-6055

DOI:

https://doi.org/10.66224/jcbior.7.3.364

Keywords:

COVID-19, Risk factors, Mortality, Lung diseases, Iran

Abstract

Coronavirus disease 2019 (COVID-19) pandemic and its rising death toll have become a global issue. To address the disease's evolving nature, it is crucial to identify factors influencing its severity. The purpose of this study was to look at the risk factors for death in COVID-19 patients with pulmonary involvement. A total of 340 patients with confirmed COVID-19 who were admitted to Shahidzadeh Hospital in Behbahan, Iran, participated in this retrospective cohort study. Between March 20, 2020, and January 20, 2021, patient data was gathered from medical records. The Cox proportional hazards regression model was used for the statistical analysis. The mean age of patients was 58.3 ± 16.71 years (range: 13–96 years) at diagnosis. Among the study population, 63 patients (18.5%) died, whereas 277 patients (81.5%) achieved clinical recovery. Dyspnea (64.1%), cough (45%), and chills (42.4%) were the most commonly reported symptoms during hospitalization. Both lungs (50%), the upper zone (16.2%), and the left lung (7.9%) were the most affected lung areas. Age (Hazard Ratio=1.03; 95% CI 1.02-1.05; P<0.001) and cardiovascular disorders (Hazard Ratio=2.71; 95% CI: 1.59-4.62; P <0.001) were associated with COVID-19 patient death, according to multivariate regression analysis. The study found a significant link between increased mortality in COVID-19 patients and factors such as old age and cardiovascular disease. These findings implement a self-care program for elderly and cardiovascular patients to help reduce mortality rates.

References

1. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(4):e26.

DOI: 10.1016/S2213-2600(20)30103-X PMID: 32105632

2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):496.

DOI: 10.1016/S0140-6736(20)30252-X PMID: 31986264

3. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. DOI: 10.1056/NEJMoa2002032 PMID: 32109013

4. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1038. DOI: 10.1016/S0140-6736(20)30638-3 PMID: 32171076

5. Ma C, Gu J, Hou P, Zhang L, Bai Y, Guo Z, et al. Incidence, clinical characteristics and prognostic factor of patients with COVID-19: a systematic review and meta-analysis. medRxiv [Preprint]. 2020. DOI: 10.1101/2020.03.17.20037572

6. Ahmadi A, Ardeshiri S, Rajab Nezhadi V, Pajoohesh A, Narimani Moghadam T, Sabaghan M, et al. Risk Factors for Mortality in Hospitalized Patients with COVID-19: A Cross-Sectional Study in Southwestern Iran. Iran Red Crescent Med J. 2021;23(9):e188922. DOI: 10.32592/ircmj.2021.23.9.1230

7. Wang Y, Dong C, Hu Y, Li C, Ren Q, Zhang X, et al. Temporal Changes of CT Findings in 90 Patients with COVID-19 Pneumonia: A Longitudinal Study. Radiology. 2020;296(2):E55-E64. DOI: 10.1148/radiol.2020200843 PMID: 32191587

8. Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020;20(4):425-434. DOI: 10.1016/S1473-3099(20)30086-4 PMID: 32105637

9. Wu J, Wu X, Zeng W, Guo D, Fang Z, Chen L, et al. Chest CT Findings in Patients with Coronavirus Disease 2019 and Its Relationship with Clinical Features. Invest Radiol. 2020;55(5):257-261. DOI: 10.1097/RLI.0000000000000670 PMID: 32091414

10. Xie Y, Wang Z, Liao H, Marley G, Wu D, Tang W. Epidemiologic, clinical, and laboratory findings of the COVID-19 in the current pandemic: systematic review and meta-analysis. BMC Infect Dis. 2020;20(1):640.

DOI: 10.1186/s12879-020-05371-2 PMID: 32867706

11. Huang M, Yang Y, Shang F, Zheng Y, Zhao W, Luo L, et al. Clinical Characteristics and Predictors of Disease Progression in Severe Patients with COVID-19 Infection in Jiangsu Province, China: A Descriptive Study. Am J Med Sci. 2020;360(4):430. DOI: 10.1016/j.amjms.2020.07.028 PMID: 32709280

12. Castelli M, Maurin A, Bartoli A, Dassa M, Marchi B, Finance J, et al. Prevalence and risk factors for lung involvement on low-dose chest CT (LDCT) in a paucisymptomatic population of 247 patients affected by COVID-19. Insights Imaging. 2024;15(1):266.

DOI: 10.1186/s13244-024-01847-w PMID: 33201409

13. Sapienza LG, Nasra K, Calsavara VF, Little TB, Narayana V, Abu-Isa E. Risk of in-hospital death associated with Covid-19 lung consolidations on chest computed tomography - A novel translational approach using a radiation oncology contour software. Eur J Radiol Open. 2021;8:100322.

DOI: 10.1016/j.ejro.2021.100322 PMID: 33432297

14. Zandkarimi E, Moradi G, Mohsenpour B. The Prognostic Factors Affecting the Survival of Kurdistan Province COVID-19 Patients: A Cross-sectional Study from February to May 2020. Int J Health Policy Manag. 2022;11(4):453-458.

DOI: 10.34172/ijhpm.2020.155 PMID: 32861230

15. Sun H, Ning R, Tao Y, Yu C, Deng X, Zhao C, et al. Risk Factors for Mortality in 244 Older Adults With COVID-19 in Wuhan, China: A Retrospective Study. J Am Geriatr Soc. 2020;68(6):E19-E23. DOI: 10.1111/jgs.16533 PMID: 32383809

16. Song J, Park DW, Cha JH, Seok H, Kim JY, Park J, et al. Clinical course and risk factors of fatal adverse outcomes in COVID-19 patients in Korea: a nationwide retrospective cohort study. Sci Rep. 2021;11(1):10066.

DOI: 10.1038/s41598-021-89548-y PMID: 33980912

17. Shahbazi F, Karami M, Mirzaei M, Mohammadi Y. Survival Rates and Prognostic Factors in Patients with Coronavirus Disease 2019: A Registry-Based Retrospective Cohort Study. J Res Health Sci. 2021;21(2):e00515. DOI: 10.34172/jrhs.2021.47 PMID: 34465638

18. Bonanad C, García-Blas S, Tarazona-Santabalbina F, Sanchis J, Bertomeu-González V, Fácila L, et al. The Effect of Age on Mortality in Patients With COVID-19: A Meta-Analysis With 611,583 Subjects. J Am Med Dir Assoc. 2020;21(7):915-918. DOI: 10.1016/j.jamda.2020.05.045 PMID: 32674819

19. Machado-Alba JE, Valladales-Restrepo LF, Machado-Duque ME, Gaviria-Mendoza A, Sánchez-Ramírez N, Usma-Valencia AF, et al. Factors associated with admission to the intensive care unit and mortality in patients with COVID-19, Colombia. PLoS One. 2021;16(11):e0260169.

DOI: 10.1371/journal.pone.0260169 PMID: 34797857

20. Kalyanaraman Marcello R, Dolle J, Grami S, Adule R, Li Z, Tatem K, et al. Characteristics and outcomes of COVID-19 patients in New York City's public hospital system. PLoS One. 2020;15(12):e0243027.

DOI: 10.1371/journal.pone.0243027 PMID: 33332356

21. Dou Q, Wei X, Zhou K, Yang S, Jia P. Cardiovascular Manifestations and Mechanisms in Patients with COVID-19. Trends Endocrinol Metab. 2020;31(12):893-904.

DOI: 10.1016/j.tem.2020.10.001 PMID: 33172748

22. Sabatino J, De Rosa S, Di Salvo G, Indolfi C. Impact of cardiovascular risk profile on COVID-19 outcome. A meta-analysis. PLoS One. 2020;15(12):e0243471.

DOI: 10.1371/journal.pone.0243471 PMID: 32797054

23. Barison A, Aimo A, Castiglione V, Arzilli C, Lupón J, Codina P, et al. Cardiovascular disease and COVID-19: les liaisons dangereuses. Eur J Prev Cardiol. 2020;27(10):1017-1025.

DOI: 10.1177/2047487320924501 PMID: 32391719