Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2022; 10(10): 3047-3059
Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3047
Dose-response relationship between risk factors and incidence of COVID-19 in 325 hospitalized patients: A multicenter retrospective cohort study
Sheng-Chao Zhao, Xian-Qiang Yu, Xue-Feng Lai, Rui Duan, De-Liang Guo, Qian Zhu
Sheng-Chao Zhao, Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
Xian-Qiang Yu, Department of Surgery, Qingdao Women and Children's Hospital affiliated to Qingdao University, Qingdao 266000, Shandong Province, China
Xue-Feng Lai, Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Rui Duan, Department of General Surgery, Jingmen First People’ Hospital, Jingmen 448000, Hubei Province, China
De-Liang Guo, Department of Hepatobiliary and Pancreatic Surgery, Ancreatic Surgery Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
Qian Zhu, Department of Hepatobiliary and Pancreatic Surgery, Pancreatic Surgery Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
Author contributions: Zhao SC and Yu XQ made equal contributions to the article; Yu XQ and Zhu Q had the idea for and designed the study and had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis; Zhao SC and Lai XF drafted the paper; Zhao J and Guo DL did the analysis, and all authors critically revised the manuscript for important intellectual content and gave final approval for the version to be published; all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Institutional review board statement: The study was reviewed and approved by the Zhongnan Hospital of Wuhan University Institutional Review Board
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: There has no conflict of interest of this study.
Data sharing statement: The datasets used or analysed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qian Zhu, Doctor, PhD, Academic Research, Doctor, Department of Hepatobiliary and Pancreatic Surgery, Pancreatic Surgery Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China. zhuqian@whu.edu.cn
Received: October 16, 2021
Peer-review started: October 16, 2021
First decision: November 17, 2021
Revised: December 13, 2021
Accepted: February 27, 2022
Article in press: February 27, 2022
Published online: April 6, 2022
Processing time: 164 Days and 6.8 Hours
Abstract
BACKGROUND

The epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) patients have been widely reported, but the assessment of dose-response relationships and risk factors for mortality and severe cases and clinical outcomes remain unclear.

AIM

To determine the dose-response relationship between risk factors and incidence of COVID-19.

METHODS

In this retrospective, multicenter cohort study, we included patients with confirmed COVID-19 infection who had been discharged or had died by February 6, 2020. We used multivariable logistic regression and Cox proportional hazard models to determine the dose-response relationship between risk factors and incidence of COVID-19.

RESULTS

It clarified that increasing risk of in-hospital death were associated with older age (HR: 1.04, 95%CI: 1.01-1.09), higher lactate dehydrogenase [HR: 1.04, 95% confidence interval (CI): 1.01-1.10], C-reactive protein (HR: 1.10, 95%CI: 1.01-1.23), and procalcitonin (natural log-transformed HR: 1.88, 95%CI: 1.22-2.88), and D-dimer greater than 1 μg/mL at admission (natural log transformed HR: 1.63, 95%CI: 1.03-2.58) by multivariable regression. D-dimer and procalcitonin were logarithmically correlated with COVID-19 mortality risk, while there was a linear dose-response correlation between age, lactate dehydrogenase, D-dimer and procalcitonin, independent of established risk factors.

CONCLUSION

Higher lactate dehydrogenase, D-dimer, and procalcitonin levels were independently associated with a dose-response increased risk of COVID-19 mortality.

Keywords: Coronavirus disease 2019; Dose-response relationship; Risk factor; Prognosis; Incidence

Core Tip: This study showed that older age, higher lactate dehydrogenase and creatinine, and elevated procalcitonin and D-dimer at admission were risk factors for the mortality from coronavirus disease 2019 (COVID-19). These findings suggested that higher lactate dehydrogenase, D-dimer and procalcitonin levels were independently associated with a dose-response increased risk of COVID-19 incidence.