Discussion
Although COVID-2019 is one of the most emergency infections today, there are limited data on risk factors of outcome. In our study of patients with COVID-19 in Harbin we have shown that 16.35% have developed of severe COVID-2019 and the percent of poor outcome was 10.58% (the mortality was 2.88%, and the percent of ICU admission or transfer to a superior hospital was 7.69%). Both are lower than the previous research which showed that 26% of patients received ICU care, and mortality was 4.3% in Wuhan 7. The lower mortality may be related to early isolation and early treatment in Harbin. ECG abnormalities and overweight are predictors of severe COVID-2019. On multivariate analysis, presence of abnormal ECG on admission and higher BMI are the two significant factors predicting outcome. The percent of poor outcomes increases with abnormal electrocardiogram.
Early identification of those “at risk” of poor outcome is an essential part of the assessment of any disease. In the study, the data of 104 patients with COVID-2019 are analyzed, the baseline characteristics of patients in the non-severe and severe groups are described and compared. The independent risk factors affecting incidence of severe illness are screened by univariate and multivariate Logistic Regression. We found that ECG abnormalities and overweight plays a key role in determining the course in severe patients with COVID-2019.
A recent study showed myocardial injury is significantly associated with fatal outcome of COVID-19, while myocardial injury is associated with cardiac dysfunction and arrhythmias 8. It is similar with our study. In our study, creatine kinase and creatine kinase MB form and ECG record were compared and used to univariate logistic regression evaluating. Neither creatine kinase nor creatine kinase MB form is associated with developing severe COVID-19. However, ECG abnormalities is associated with the outcome. This is also similar to the observation in patients with sepsis, where the heart rate variability which calculated by electrocardiogram recording seemed to be the best indicator to predict the occurrence of septic shock9 or mortality 10.
Another research showed is neutrophil-to-lymphocyte ratio is an independent risk factor for mortality in hospitalized patients with COVID-19 11. In that research focused on a series of predictors such as age, gender, symptoms and blood laboratory findings, except BMI and ECG results. However, in other publications evaluating the BMI was a predictor of microbiological persistence in patients with mycobacterium avium complex lung disease 12. The virus persistence in respiratory might imply a lymphoid hypertrophy and a stimulatory effect for inflammation 13. Virus persistence may have a pathogenetic potential for development of lymphoid hypertrophy and a chronic stimulatory effect for inflammation.
In this study, we first quantify the total direct economic burden of COVID-2019 related hospitalizations. Because of the high spread of the disease, all patents were hospitalized. The median cost per patient is ¥11805.98 and higher in severe patients. The medical costs per patient of COVID-2019 in Harbin is higher than influenza hospitalisation costs of ¥9832.00 in China 14, but lower than that of
The limitations of our study is a single center study and the small sample size. In addition, the laboratory test of cardiac function examination, including Troponin I and brain natriuretic peptide, cannot be acquired in the medical records. Third, the medical costs data has been obtained from a middle city, which may not be applicable to the other city or country.