Lancet study identifies key death risks with coronavirus

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

The new study of 191 patients with confirmed COVID-19 fromtwo hospitals in Wuhan, China, is the first time researchers have examined riskfactors 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 underlyingchronic conditions (48 per cent, 91 patients) — the most common being highblood pressure, and diabetes.

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

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

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

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

“The extended viral shedding has important implicationsfor guiding decisions around isolation precautions and antiviral treatment inpatients with confirmed COVID-19 infection,” explained co-lead authorProfessor Bin Cao from the China-Japan Friendship Hospital and Capital MedicalUniversity, China

However, “We need to be clear that viral shedding timeshould not be confused with other self-isolation guidance for people who mayhave been exposed to COVID-19 but do not have symptoms, as this guidance isbased 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 diseaseslike high blood pressure and diabetes, and the prolonged use of non-invasiveventilation were important factors in the deaths of these patients.

Poorer outcomes in older people may be due, in part, to theage-related weakening of the immune system and increased inflammation thatcould 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 pictureof 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 ofsurvivors still had cough on discharge.

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

The study also illustrates the time of the occurrence ofdifferent 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 shouldbe required before patients are discharged from hospital. In severe influenza,delayed viral treatment extends how long the virus is shed, and together thesefactors put infected patients at risk of dying,” said Bin Cao.

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

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