The Impact of Significant Risk Factors on the Mortality Rate of Hospitalized COVID-19 Patients in the Iranian Population

Document Type : Original Article

Authors

1 Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.

10.22038/psj.2025.84457.1451

Abstract

Introduction:
The present study aimed to assess the respiratory signs and laboratory parameters in COVID-19 patients based on recovery or mortality during hospitalization in the Iranian population.
 Materials and Methods:
623 patients over 16 years of age with confirmed COVID-19 infection using polymerase chain reaction test who were admitted to the COVID-19 wards of Imam Reza Hospital from 2020 to 2022 were included in this study. The vital signs and paraclinical parameters such as liver and renal function tests as well as hematological and inflammatory markers were evaluated based on recovered or non-recovered patients during admission.
 Results:
According to our results, 135 COVID-19 patients (21.7%) expired, while 488 patients recovered through hospitalization. The frequency of acute kidney injury was significantly higher in unrecovered COVID-19 patients (71.1%) compared to the recovered group (27.3%) (p<0.001). Significant differences were found in terms of AST, direct and total bilirubin, creatinine, BUN, albumin, LDH, and CRP, as well as potassium, phosphorus, calcium, pH, HCO3, and INR serum levels between groups at both baseline and endpoint admission. The non-recovered patients demonstrated significantly higher counts of WBC, MCV, RDW, and neutrophil, as well as significantly lower amounts of RBC, hemoglobin, platelet, lymphocyte, and MXD than the recovered group during admission.
 Conclusion:
Our findings revealed that AKI, CRP, LDH, WBC, RDW, neutrophil, and PLT were the significant risk factors in the incidence of mortality due to COVID-19 infection in the present study. These results could be helpful in screening and managing hospitalized patients during the respiratory viral pandemic.

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  1. Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. New England journal of medicine. 2020;382(10):970-1.
  2. Bailly L, Fabre R, Courjon J, Carles M, Dellamonica J, Pradier C. Obesity, diabetes, hypertension and severe outcomes among inpatients with coronavirus disease 2019: a nationwide study. Clinical Microbiology and Infection. 2022;28(1):114-23.
  3. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The lancet. 2020;395(10223):507-13.
  4. Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Critical reviews in clinical laboratory sciences. 2020;57(6):389-99.
  5. Liu T, Zhang J, Yang Y, Ma H, Li Z, Zhang J, et al. The role of interleukin‐6 in monitoring severe case of coronavirus disease 2019. EMBO molecular medicine. 2020;12(7):e12421.
  6. Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-system inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection: review of clinical presentation, hypothetical pathogenesis, and proposed management. Children. 2020;7(7):69.
  7. Rouhbakhsh Zahmatkesh MR, Soleimanpour S, Mirfeizi Z, Milani N. Prognostic Factor Predicting Severity of COVID-19: Narrative Review. Reviews in Clinical Medicine. 2021;8(1):19-26.
  8. Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID‐19. Journal of medical virology. 2020; 92(7): 791-6.
  9. Hundt MA, Deng Y, Ciarleglio MM, Nathanson MH, Lim JK. Abnormal liver tests in COVID‐19: a retrospective observational cohort study of 1,827 patients in a major US hospital network. Hepatology. 2020;72(4):1169-76.
  10. Abdirad A G-SS, Shuyama K, Koriyama C, Nadimi-Barforoosh H, Emami S, et al. Epstein-Barr virus associated gastric carcinoma: a report from Iran in the last four decades. Diagnostic Pathology. 2007;2(1):25.
  11. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2018;68(6):394-424.
  12. Banu N, Chia A, Ho ZZ, Garcia AT, Paravasivam K, Grotenbreg GM, et al. Building and optimizing a virus-specific T cell receptor library for targeted immunotherapy in viral infections. Scientific reports. 2014;4:4166.
  13. Akintola-Ogunremi O, Luo Q, He TC, Wang HL. Is cytomegalovirus associated with human colorectal tumorigenesis? American journal of clinical pathology. 2005;123(2):244-9.
  14. Wijarnpreecha K, Ungprasert P, Panjawatanan P, Harnois DM, Zaver HB, Ahmed A, et al. COVID-19 and liver injury: a meta-analysis. European Journal of Gastroenterology & Hepatology. 2021;33(7):990-5.
  15. Adapa S, Chenna A, Balla M, Merugu GP, Koduri NM, Daggubati SR, et al. COVID-19 pandemic causing acute kidney injury and impact on patients with chronic kidney disease and renal transplantation. Journal of clinical medicine research. 2020;12(6):352.
  16. Ghahramani S, Tabrizi R, Lankarani KB, Kashani SMA, Rezaei S, Zeidi N, et al. Laboratory features of severe vs. non-severe COVID-19 patients in Asian populations: a systematic review and meta-analysis. European journal of medical research. 2020;25(1):1-10.
  17. Zimmer MA, Zink AK, Weißer CW, Vogt U, Michelsen A, Priebe H-J, et al. Hypernatremia—a manifestation of COVID-19: a case series. A&a Practice. 2020;14(9):e01295.
  18. Lippi G, South AM, Henry BM. Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19). Annals of clinical biochemistry. 2020;57(3):262-5.
  19. Aktar S, Ahamad M, Rashed-Al-Mahfuz M, Azad A, Uddin S, Kamal A, et al. Predicting patient COVID-19 disease severity by means of statistical and machine learning analysis of blood cell transcriptome data. arXiv preprint arXiv:201110657. 2020.
  20. Dheir H, Karacan A, Sipahi S, Yaylaci S, Tocoglu A, Demirci T, et al. Correlation between venous blood gas indices and radiological involvements of COVID-19 patients at first admission to emergency department. Revista da Associação Médica Brasileira. 2021;67:51-6.
  21. Payán-Pernía S, Gómez Pérez L, Remacha Sevilla ÁF, Sierra Gil J, Novelli Canales S. Absolute lymphocytes, ferritin, C-reactive protein, and lactate dehydrogenase predict early invasive ventilation in patients with COVID-19. Laboratory medicine. 2021;52(2):141-5.
  22. Taj S, Fatima SA, Imran S, Lone A, Ahmed Q. Role of hematological parameters in the stratification of COVID-19 disease severity. Annals of medicine and surgery. 2021;62:68-72.
  23. Wang C, Zhang H, Cao X, Deng R, Ye Y, Fu Z, et al. Red cell distribution width (RDW): a prognostic indicator of severe COVID-19. Annals of translational medicine. 2020;8(19).