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Multivariable analysis of clinical and laboratory data manifestations predicting severity and mortality risk in patients with Coronavirus disease 2019 in the mountainous west of Iran: a retrospective single-center study

Zahra Naderi Beni
Zahra Naderi Beni
, 
Afsaneh Naderi Beni
Afsaneh Naderi Beni
, 
Fereidoun Rahmani Samani
Fereidoun Rahmani Samani
, 
Mohammad Ali Dayani
Mohammad Ali Dayani
, 
Fariba Naderi Beni
Fariba Naderi Beni
, 
Hamed Radmehr
Hamed Radmehr
 und 
Pegah Noorshargh
Pegah Noorshargh
   | 28. Feb. 2022
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Article Category: Original article
Online veröffentlicht: 28. Feb. 2022
Seitenbereich: 31 - 42
DOI: https://doi.org/10.2478/abm-2022-0005
Schlüsselwörter
© 2022 Zahra Naderi Beni et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Flowchart for the inclusion and exclusion criteria for the patient samples. COVID-19, coronavirus disease-2019; CT, computed tomography; RT-PCR, reverse transcriptase-polymerase chain reaction.
Flowchart for the inclusion and exclusion criteria for the patient samples. COVID-19, coronavirus disease-2019; CT, computed tomography; RT-PCR, reverse transcriptase-polymerase chain reaction.

Univariate logistic analysis of the severity and mortality of COVID-19

Variable Severity Mortality
OR Lower–upper P OR Lower–upper P
Age 1.03 1.02–1.04 <0.001*** 1.04 1.01–1.07 0.003**
Sex 1.02 0.63–1.65 0.942 0.79 0.31–2.06 0.63
Comorbidity 2.47 1.51–4.03 <0.001*** 4.25 1.36–13.26 0.013*
Time from illness onset to first admission [median (IQR)] 1.07 1.00–1.15 0.48 1.12 1.02–1.23 0.013*
Time from admission to discharge/death [median (IQR)] 1.06 0.99–1.14 0.06 1.13 1.02–1.24 0.012*
Albumin 1.04 0.66–1.64 0.86 0.69 0.28–1.70 0.42
ALK-p 0.998 0.996–1.000 0.053 0.998 0.99–1.00 0.38
Direct bilirubin 0.92 0.57–1.50 0.74 1.11 0.55–2.27 0.77
Total bilirubin 1.08 0.77–1.52 0.66 1.20 0.82–1.78 0.35
Calcium 1.06 0.71–1.59 0.77 1.24 0.11–0.51 <0.001***
Corrected calcium 0.97 0.63–1.49 0.89 1.42 0.21–0.81 0.01*
CRP 1.01 0.98–1.04 0.58 0.98 0.88–1.09 0.64
ESR 1.01 0.996–1.016 0.27 1.00 0.98–1.02 0.80
Hematocrit 1.06 1.02–1.10 0.004** 1.03 0.96–1.12 0.40
Hemoglobin 1.12 1.01–1.24 0.030* 1.09 0.89–1.33 0.40
LDH 1.00 1.000–1.003 0.016* 1.00 1.000–1.001 0.024*
Lymphocyte count (/μL) 0.81 0.64–1.03 0.090 1.08 0.74–1.57 0.69
Lymphocyte percentage 0.97 0.95–0.99 0.004** 0.99 0.94–1.03 0.50
Mean corpuscular Hb concentration 0.95 0.86–1.05 0.30 0.95 0.79–1.14 0.55
Mean cell hemoglobin 0.99 0.92–1.06 0.73 1.07 0.92–1.25 0.38
Mean cell volume 1.01 0.98–1.04 0.53 1.05 0.98–1.12 0.19
Mean platelet volume 0.97 0.91–1.04 0.39 1.01 0.94–1.08 0.76
Mixed cell count 0.84 0.58–1.23 0.38 0.79 0.24–2.55 0.69
Mixed cell percentage 0.95 0.90–1.00 0.062 0.89 0.77–1.03 0.12
Neutrophil count 1.06 1.01–1.13 0.03* 1.04 0.95–1.13 0.42
Neutrophil percentage 1.01 0.996–1.021 0.17 1.01 0.98–1.03 0.61
P-LCR 0.996 0.97–1.02 0.75 1.04 0.99–1.10 0.11
Platelet distribution width 1.00 0.93–1.07 >0.99 1.12 0.95–1.32 0.18
Phosphorus 0.82 0.66–1.01 0.063 0.36 0.19–0.69 0.002**
Platelet count (×103/μL) 1 1–1 0.96 1.00 1.000–1.000 0.010*
Potassium 0.97 0.57–1.65 0.91 0.30 0.09–0.97 0.045*
RBC count 1.39 1.03–1.88 0.033* 0.62 0.39–1.00 0.049*
RDW–CV 1.20 1.06–1.37 0.005** 1.04 0.84–1.29 0.71
RDW–SD 1.06 1.01–1.10 0.009** 1.03 0.97–1.10 0.34
AST 1.01 1.00–1.01 0.074 1.00 1.00–1.01 0.14
Alanine transaminase 1.01 0.999–1.011 0.14 1.00 0.998–1.003 0.81
Sodium 0.94 0.891–0.998 0.043* 0.90 0.80–1.01 0.07
White blood cell count (/μL) 1.00 1.00–1.00 0.59 1.00 1.00–1.00 0.89

Logistic regression of risk factors related to severity of COVID-19

Variable B SE OR 95% CI Wald statistic P
Age 0.23 0.007 1.02 1.01–1.04 10.5 0.001**
Hematocrit 0.076 0.025 1.08 1.03–1.13 9.42 0.002**
RDW-CV 0.162 0.073 1.18 1.02–1.36 4.95 0.02*
Comorbidity 0.619 0.303 1.86 1.03–3.36 4.19 0.04*

Demographic data and baseline characteristics at admission of patients infected with COVID-19 who survived and those who did not

Variablen (%) or median (IQR) All patientsn = 286 Moderaten = 134 Severen = 152 P Survivedn = 268 Did not surviven = 18 P
Age (range) years 53 (36, 71) 43 (29, 67) 61 (46, 74) <0.001 52 (35, 70) 73 (60, 79) 0.001
0–14 years 18 15 3 18 0
15–49 years 105 63 42 105 0
50–64 years 56 26 30 51 5
≥65 years 107 30 77 94 13
Female/male 128/158 61/73 67/85 0.94 120/148 8/10 0.37
Fever on admission 155 (54.1) 75 (56) 80 (53) 0.59 145 (54) 10 (56) 0.85
Myalgia or arthralgia 76 (26.5) 36 (27) 40 (26) 0.89 70 (26) 6 (33) 0.60
Cough 177 (61.9) 87 (65) 90 (59) 0.53 154 (57) 14 (78) 0.21
Dyspnea 144 (50.3) 70 (52) 74 (48) 0.41 133 (50) 11 (61) 0.45
Confusion 31 (10.8) 17 (13) 14 (9) 0.33 25 (9) 6 (33) 0.09
Seizure 1 (0.4) 1 (1) 0 (0) 0.28 0 1 (6) 0.69
Headache 134 (46.8) 69 (52) 67 (44) 0.35 121 (45) 13 (72) 0.27
Chest pain 41 (14.3) 19 (14) 22 (15) 0.96 36 (13) 5 (28) 0.27
Abdominal pain 19 (6.6) 11 (8) 8 (5) 0.31 18 (7) 1 (6) 0.28
Nausea 32 (11.1) 14 (10) 18 (12) 0.72 31 (12) 1 (6) 0.19
Vomiting 23 (8.04) 13 (10) 10 (7) 0.32 22 (8) 1 (6) 0.20
Diarrhea 5 (1.7) 3 (2) 2 (1) 0.64 4 (2) 1 (6) 0.20
Comorbidity 135 (47.2) 48 (36) 87 (57) 0.006 121 (45) 14 (78) 0.007
  Cancer 5 (1.7) 2)2) 3 (2) 0.76 4 (2) 1 (6) 0.25
  Liver 2 (0.7) 2 (2) 0 (0) 0.06 2 (1) 0 0.69
  Diabetes mellitus 43 (15.0) 12 (9) 31 (20) 0.02 38 (14) 5/15 (28) 0.19
  Hematology 4 (1.4) 2 (2) 2 (1) 0.48 4 (2) 0 0.58
  Pregnancy 7 (2.4) 7 (5) 0 (0) 0.007 7/259 (3) 0 0.026
  Heart disease 51 (17.8) 17 (13) 34 (22) 0.15 45 (17) 6 (33) 0.14
  Hypertension 80 (28.0) 17 (13) 63 (42) 0.014 75 (28) 5 (28) 0.86
  Asthma 9 (3.1) 5 (4) 4 (3) 0.058 9/257 (3) 0 0.40
  COPD 38 (13.3) 9 (7) 29 (19) 0.006 35 (13) 3 (17) 0.80
  Neurology 16 (5.6) 7 (5) 9 (6) 0.8 14 (5) 2 (11) 0.37
  Other 40 (14.0) 15 (11) 25 (17) 0.26 39 (15) 1 (6) 0.23
Time from illness onset to first admission 4 (3, 7) 4 (2, 6) 4 (3, 7) 0.023 4 (3, 6) 7 (3, 10.5) 0.045
Time from admission to discharge/death 15 (14, 19) 15 (13, 18) 15 (14, 19) 0.047 15 (14, 18) 18 (14, 21.5) 0.031
First oxygen mode
  No oxygen inhalation 144 (50.3) 91 (68) 0 (0) <0.001 143 (53) 1 (10) <0.001
  Nasal catheter for oxygen 117 (40.9) 43 (32) 130 (86) 113 (42) 4 (22)
  Face mask oxygen inhalation 16 (5.6) 0 17 (11) 12 (4) 4 (22)
  High-flow oxygen 5 (1.7) 0 5 (3) 0 5 (28)
  Noninvasive ventilation 4 (1.4) 0 0 4 (22)
  Tracheal intubation 0 0 0 0

Area under the ROC curve and optimal threshold of each COVID-19-related variable

Variables AUC 95% CI P Optimal threshold Sensitivity Specificity
Calcium 0.759 0.69–0.82 0.001** ≤6.4 64.7 59.1
LDH 0.731 0.64–0.81 0.039* >4,622 55.6 92.7
Phosphorus 0.725 0.66–0.79 <0.001** ≤1.5 76.5 69.2
Bilirubin Total 0.689 0.61–0.76 0.003** >4.8 66.7 69.4
Total CRP 0.679 0.62–0.74 0.013* >90 53.3 83.1
RDW SD 0.624 0.56–0.68 0.035* >79.3 88.9 38.2

Logistic regression of risk factors related to mortality of patients with COVID-19

Variable B SE OR 95% CI Wald statistic P
Calcium −1.453 0.466 0.20 0.09–0.58 9.726 0.002**
Phosphorus −0.662 0.346 0.50 0.26–1.02 3.651 0.04*
P-LCR 0.069 0.035 1.10 1.00–1.15 994 0.04*
Age 0.034 0.017 1.00 1.00–1.07 4.039 0.03*

Laboratory findings at admission of patients infected with SARS-CoV-2

Variable, median (IQR) Total Disease severity Mortality
Admission data Moderate Severe P Survived Did not survive P
Albumin (g/dL) 3.2 (2.9, 3.5) 3.2 (2.83, 3.5) 3.2 (2.8, 3.5) 0.57 3.2 (2.9, 3.5) 3.0 (2.75, 3.5) 0.38
ALK-p (IU/L) 180 (142, 254) 172 (144, 276) 188 (138, 246) 0.90 180 (139, 262) 193 (144, 239) 0.90
Direct bilirubin (mg/dL) 0.2 (0.1, 0.4) 0.2 (0.1, 0.4) 0.2 (0.1, 0.4) 0.78 0.2 (0.1, 0.4) 0.4 (0.2, 0.6) 0.01*
Total bilirubin (mg/dL) 0.6 (0.4, 1.0) 0.5 (0.4, 0.82) 0.6 (0.4, 1.12) 0.29 0.5 (0.4, 0.9) 0.9 (0.65, 1.4) 0.01*
Calcium (mg/dL) 8.3 (8.0, 8.7) 8.3 (8.0, 8.7) 8.3 (8.0, 8.7) 0.56 8.4 (8.0, 8.7) 8.0 (7.2, 8.2) <0.001***
Corrected calcium (mg/dL) 8.96 (8.56, 9.28) 8.94 (8.44, 9.26) 8.94 (8.57, 9.35) 0.56 8.98 (8.62, 9.34) 8.68 (7.91, 9.02) 0.01*
CRP (mg/L) 10.0 (4.0, 15.5) 8.0 (4.0, 16.0) 10.0 (3.5, 15.0) 0.90 9.5 (4.0, 16.0) 10 (2.0, 13.0) 0.68
ESR (mm/h) 30 (13, 51) 26 (13, 50) 33 (14.5, 53) 0.30 29 (13, 51) 32 (18.8, 53.3) 0.64
Hematocrit (%) 40.0 (36.1, 43.6) 39.8 (36.1, 42.8) 41.6 (36.4, 44.6) 0.027* 40.0 (36.1, 43.3) 41.1 (36.0, 44.9) 0.53
Hemoglobin (g/dL) 13.8 (11.8, 15.2) 13.4 (12.0, 14.9) 14.0 (11.9, 15.4) 0.093 13.8 (11.9, 15.1) 14.5 (11.4, 16.3) 0.54
LDH (U/L) 568 (411, 839) 466 (398, 667) 656 (456, 919) 0.006** 559 (400, 778) 1,187 (567, 1,534) 0.022*
Lymphocyte count (×103/μL) 1.3 (0.9, 1.9) 1.4 (0.9, 2.1) 1.3 (0.95, 1.8) 0.34 1.4 (0.97, 1.9) 1.00 (0.4, 2.02) 0.13
Lymphocytes (%) 18.9 (12, 28.0) 20.5 (13.2, 31.7) 16.9 (11.3, 25.3) 0.01* 18.9 (12.0, 28.1) 18.7 (12.1, 22.4) 0.5
Mean corpuscular hemoglobin concentration (g/dL) 34.2 (32.4, 35.3) 34.6 (32.7, 35.6) 33.9 (32.3, 35.0) 0.07 34.2 (32.5, 35.3) 33.5 (32.05, 35.6) 0.63
Mean cell hemoglobin (pg) (mean ± SD) 30.11 ± 3.44 30.18 ± 3.03 30.04 ± 3.77 0.73 30.06 ± 3.35 30.79 ± 4.67 0.38
Mean corpuscular volume (fL) 89.9 (85.6, 93.5) 89.3 (85.6, 92.9) 90.7 (85.8, 94.6) 0.11 89.9 (85.4, 93.4) 91.0 (87.8, 97.5) 0.11
Mean platelet volume (fL) 9.2 (8.6, 10.1) 9.3 (8.7, 10.1) 9.1 (8.5, 10.1) 0.40 9.2 (8.6, 10.0) 9.3 (8.67, 10.9) 0.34
Mixed cell count (×103/μL) 0.4 (0.12, 0.7) 0.4 (0.2, 0.7) 0.4 (0.1, 0.6) 0.53 0.4 (0.19, 0.7) 0.2 (0, 0.65) 0.32
Mixed cell (%) 5.4 (3.0, 8.5) 6.0 (3.3, 9.2) 5.0 (3.0, 8.0) 0.07 5.4 (3.1, 8.6) 4.7 (2.2, 8.2) 0.13
Neutrophil count (×103/μL) 4.5 (2.6, 7.6) 4.1 (3.0, 6.1) 4.7 (2.4, 8.3) 0.12 4.5 (2.6, 7.4) 5.2 (3.1, 8.7) 0.39
Neutrophil (%) 73.7 (62.0, 83.0) 71.3 (59.1, 80.9) 76.05 (63.6, 83.7) 0.02* 73.2 (61.6, 83.1) 76.1 (71.4, 81.6) 0.39
Potassium (mmol/L) 4.0 (3.8, 4.3) 4.0 (3.8, 4.3) 4.0 (3.7, 4.3) 0.80 4.0 (3.8, 4.3) 3.9 (3.4, 4.0) 0.29
P-LCR 21.6 (16.5, 27.8) 71.3 (59.1, 80.9) 21.3 (16.2, 27.5) 0.53 21.6 (16.5, 27.7) 22.2 (18.2, 33.2) 0.23
Platelet distribution width (%) 11.2 (9.9, 12.9) 11.3 (9.9, 12.9) 11.1 (9.8, 12.85) 0.74 11.2 (9.9, 12.8) 11.5 (9.9, 13.3) 0.71
Phosphorus (mg/dL) 3.3 (2.6, 4.1) 3.3 (2.8, 4.3) 3.3 (2.5, 4.0) 0.25 3.4 (2.7, 4.2) 2.7 (2.1, 3.2) 0.002**
Platelet count (×102/μL) 1,820 (1,405, 2,435) 1,900 (1,480, 2,515) 1,790 (1,350, 2,410) 0.21 1,845 (1,410, 2,417) 1,490 (1,360, 4,875) 0.90
RBC count (×106/μL) (mean ± SD) 4.39 ± 0.84 4.27 ± 0.82 4.49 ± 0.85 0.029* 4.41 ± 0.81 4.00 ± 1.15 0.047*
RDW – CV (%) 13.7 (13.1, 15.0) 13.6 (12.9, 14.4) 13.9 (13.3, 15.4) 0.007** 13.7 (13.2, 14.9) 13.9 (13.0, 15.9) 0.64
RDW – SD (fL) 47.3 (44.2, 50.6) 46.4 (43.3, 49.3) 48.3 (45.1, 52.3) <0.001* 46.9 (44.0, 50.3) 49.2 (46.4, 51.9) 0.07
AST (U/L) 26 (18, 50) 24 (18, 47) 28 (19, 57) 0.23 26 (18, 47) 41 (20, 147) 0.12
Alanine transaminase (U/L) 25 (12, 47) 24 (13, 44) 26 (12, 52) 0.27 24 (12, 46) 29 (20, 69) 0.28
Sodium (mEq/L) 137 (135, 140) 138 (136, 140) 136 (134, 139) 0.008** 137 (135, 140) 135 (133, 138) 0.05
White blood cell count (/μL) 7,200 (5,400, 10,525) 7,050 (5,225, 9,650) 7,300 (5,400,10,675) 0.28 7,200 (5,400, 10,500) 7,600 (4,375, 11,475) 0.90
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