BACKGROUND: Mortality from COVID-19 has been associated with older age, black race, and comorbidities including obesity, Understanding the clinical risk factors and laboratory biomarkers associated with severe and fatal COVID-19 will allow early interventions to help mitigate adverse outcomes . Our study identified risk factors for in-hospital mortality among patients with COVID-19 infection at a tertiary care center, in Detroit, Michigan .

METHODS: We conducted a single-center, retrospective cohort study at a 776-bed tertiary care urban academic medical center . Adult inpatients with confirmed COVID-19 (nasopharyngeal swab testing positive by real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay) from March 8, 2020, to June 14, 2020, were included . Clinical information including the presence of comorbid conditions (according to the Charlson Weighted Index of Comorbidity (CWIC) ), initial vital signs, admission laboratory markers and management data were collected . The primary outcome was in-hospital mortality .

RESULTS: Among 565 hospitalized patients, 172 patients died for a case fatality rate of 30.4% . The mean (SD) age of the cohort was 64.4 (16.2) years, and 294 (52.0 %) were male . The patients who died were significantly older (mean [SD] age , 70.4 [14.1] years vs 61.7 [16.1] years; P <0.0001), more likely to have congestive heart failure (35 [20.3 %] vs 47 [12.0 %]; P = 0.009), dementia (47 [27.3 %] vs 48 [12.2 %]; P <0.0001), hemiplegia (18 [10.5 %] vs 18 [4.8 %]; P = 0.01) and a diagnosis of malignancy (16 [9.3 %] vs 18 [4.6 %]; P = 0.03) .From multivariable analysis, factors associated with an increased odds of death were age greater than 60 years (OR = 2.2, P = 0.003), CWIC score (OR = 1.1, P = 0.023), qSOFA (OR = 1.7, P <0.0001), WBC counts (OR = 1.1, P = 0.002), lymphocytopenia (OR = 2.0, P = 0.003), thrombocytopenia (OR = 1.9, P = 0.019), albumin (OR = 0.6, P = 0.014), and AST levels (OR = 2.0, P = 0.004) on admission .

CONCLUSIONS: This study identified risk factor for in-hospital mortality among patients admitted with COVID-19 in a tertiary care hospital at the onset of U.S. Covid-19 pandemic . After adjusting for age, CWIC score, and laboratory data, qSOFA remained an independent predictor of mortality . Knowing these risk factors may help identify patients who would benefit from close observations and early interventions.