PLoS ONE (Jan 2021)

Risk factors for in-hospital mortality in laboratory-confirmed COVID-19 patients in the Netherlands: A competing risk survival analysis.

  • Gerine Nijman,
  • Maike Wientjes,
  • Jordache Ramjith,
  • Nico Janssen,
  • Jacobien Hoogerwerf,
  • Evertine Abbink,
  • Marc Blaauw,
  • Ton Dofferhoff,
  • Marjan van Apeldoorn,
  • Karin Veerman,
  • Quirijn de Mast,
  • Jaap Ten Oever,
  • Wouter Hoefsloot,
  • Monique H Reijers,
  • Reinout van Crevel,
  • Josephine S van de Maat

DOI
https://doi.org/10.1371/journal.pone.0249231
Journal volume & issue
Vol. 16, no. 3
p. e0249231

Abstract

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BackgroundTo date, survival data on risk factors for COVID-19 mortality in western Europe is limited, and none of the published survival studies have used a competing risk approach. This study aims to identify risk factors for in-hospital mortality in COVID-19 patients in the Netherlands, considering recovery as a competing risk.MethodsIn this observational multicenter cohort study we included adults with PCR-confirmed SARS-CoV-2 infection that were admitted to one of five hospitals in the Netherlands (March to May 2020). We performed a competing risk survival analysis, presenting cause-specific hazard ratios (HRCS) for the effect of preselected factors on the absolute risk of death and recovery.Results1,006 patients were included (63.9% male; median age 69 years, IQR: 58-77). Patients were hospitalized for a median duration of 6 days (IQR: 3-13); 243 (24.6%) of them died, 689 (69.9%) recovered, and 74 (7.4%) were censored. Patients with higher age (HRCS 1.10, 95% CI 1.08-1.12), immunocompromised state (HRCS 1.46, 95% CI 1.08-1.98), who used anticoagulants or antiplatelet medication (HRCS 1.38, 95% CI 1.01-1.88), with higher modified early warning score (MEWS) (HRCS 1.09, 95% CI 1.01-1.18), and higher blood LDH at time of admission (HRCS 6.68, 95% CI 1.95-22.8) had increased risk of death, whereas fever (HRCS 0.70, 95% CI 0.52-0.95) decreased risk of death. We found no increased mortality risk in male patients, high BMI or diabetes.ConclusionOur competing risk survival analysis confirms specific risk factors for COVID-19 mortality in a the Netherlands, which can be used for prediction research, more intense in-hospital monitoring or prioritizing particular patients for new treatments or vaccination.