Lancet study identifies key death risks with coronavirus

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Being of an older age, showing signs of sepsis, and having blood clotting issues when admitted to hospital are key risk factors associated with higher risk of death from the new coronavirus (COVID-19), according to a new Lancet study.

The new study of 191 patients with confirmed COVID-19 from two hospitals in Wuhan, China, is the first time researchers have examined risk factors associated with severe disease and death in hospitalised adults.

On average, patients were middle-aged (median age 56 years), most were men (62 per cent, 119 patients), and around half had underlying chronic conditions (48 per cent, 91 patients) — the most common being high blood pressure, and diabetes.

In the study of 191 patients, 137 were discharged and 54 died in hospital.

Compared with survivors, patients who died were more likely to be older (average age 69 years vs 52 years).

In addition, new data indicate that the median duration of viral shedding was 20 days in survivors (ranging from 8 to 37 days), and the virus was detectable until death in the 54 non-survivors.

While prolonged viral shedding suggests that patients may still be capable of spreading COVID-19, the authors caution that the duration of viral shedding is influenced by disease severity.

“The extended viral shedding has important implications for guiding decisions around isolation precautions and antiviral treatment in patients with confirmed COVID-19 infection,” explained co-lead author Professor Bin Cao from the China-Japan Friendship Hospital and Capital Medical University, China

However, “We need to be clear that viral shedding time should not be confused with other self-isolation guidance for people who may have been exposed to COVID-19 but do not have symptoms, as this guidance is based on the incubation time of the virus.”

According to co-author Dr Zhibo Liu from Jinyintan Hospital, China, older age, showing signs of sepsis on admission, underlying diseases like high blood pressure and diabetes, and the prolonged use of non-invasive ventilation were important factors in the deaths of these patients.

Poorer outcomes in older people may be due, in part, to the age-related weakening of the immune system and increased inflammation that could promote viral replication and more prolonged responses to inflammation, causing lasting damage to the heart, brain, and other organs

For the first time, the study described the complete picture of the progression of the COVID-19.

The median duration of fever was about 12 days in survivors, which was similar in non-survivors.

But the cough may last for a long time — 45 per cent of survivors still had cough on discharge.

In survivors, dyspnoea (shortness of breath) would cease after about 13 days, but would last until death in non-survivors.

The study also illustrates the time of the occurrence of different complications such as sepsis, acute respiratory distress syndrome (ARDS), acute cardiac injury, acute kidney injury and the secondary infection.

“We recommend that negative tests for COVID-19 should be required before patients are discharged from hospital. In severe influenza, delayed viral treatment extends how long the virus is shed, and together these factors put infected patients at risk of dying,” said Bin Cao.

The authors note that interpretation of their findings might be limited by the study’s sample size.