{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T23:17:50Z","timestamp":1780355870537,"version":"3.54.1"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T00:00:00Z","timestamp":1728345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The purpose of this study was to identify independent risk factors affecting patient survival and explore predictors of severe cases of coronavirus disease 2019 (COVID-19).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective, observational, case\u2013control study on adult patients with severe COVID-19 who were admitted to affiliated hospitals in Tianjin between December 18, 2022, and January 31, 2023. We used univariate and multifactorial logistic regression analyses to analyze demographic indicators, comorbidity profiles, and laboratory parameters in two groups of patients (deceased and surviving) to identify independent risk factors for death in patients with severe COVID-19.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients in the deceased group were older than those in the survival group (<jats:italic>p<\/jats:italic>\u2009=\u20090.018), and there were more cases of coexisting respiratory insufficiency in the deceased group (<jats:italic>p<\/jats:italic>\u2009=\u20090.002). Additionally, laboratory test results for white blood cell count (WBC) and creatine kinase (CK) showed significantly higher values in the deceased group (<jats:italic>p<\/jats:italic>\u2009=\u20090.047 and <jats:italic>p<\/jats:italic>\u2009=\u20090.029, respectively), while arterial oxygen partial pressure (PAO2) showed significantly lower values compared to the survival group (<jats:italic>p<\/jats:italic>\u2009=\u20090.021). Age, respiratory insufficiency, WBC<jats:sub>H<\/jats:sub> (highest WBC value), CK<jats:sub>H<\/jats:sub> (highest CK value), and PAO2<jats:sub>F<\/jats:sub> (first PAO2 value) had area under curve (AUC) values of 0.698, 0.838, 0.721, 0.744, and 0.633, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The main risk factors for mortality in patients with severe COVID-19 that we identified in this study were the advanced age of patients, coexisting respiratory insufficiency, elevated levels of WBC and CK, and decreased levels of PAO2. Elevated WBC and CK laboratory parameters, in particular, demonstrated good predictive value for in-hospital mortality risk.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1424720","type":"journal-article","created":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T04:38:14Z","timestamp":1728362294000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case\u2013control study on risk factors for in-hospital mortality in patients with severe COVID-19"],"prefix":"10.3389","volume":"12","author":[{"given":"Kemei","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangqin","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuhan","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinling","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yupei","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,10,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1038\/s41586-020-2012-7","article-title":"A pneumonia outbreak associated with a new coronavirus of probable bat origin","volume":"579","author":"Zhou","year":"2020","journal-title":"Nature"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2603","DOI":"10.1056\/NEJMoa2034577","article-title":"C4591001 clinical trial group. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine","volume":"383","author":"Polack","year":"2020","journal-title":"N Engl J Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1002\/jmv.25678","article-title":"Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle","volume":"92","author":"Lu","year":"2020","journal-title":"J Med Virol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"279","DOI":"10.4103\/2311-8571.353502","article-title":"Traditional Chinese medicines against COVID-19: a global overview","volume":"8","author":"Yao","year":"2022","journal-title":"World J Tradit Chin Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"61","DOI":"10.4103\/2311-8571.358784","article-title":"Identification of SARS-CoV-2 spike protein inhibitors from Urtica dioica to develop herbal-based therapeutics against COVID-19","volume":"9","author":"Upreti","year":"2023","journal-title":"World J Tradit Chin Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"81","DOI":"10.4103\/2311-8571.351792","article-title":"Traditional Chinese medicine pattern classification and herbal medicine for COVID-19","volume":"9","author":"Gao","year":"2023","journal-title":"World J Tradit Chin Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention","volume":"323","author":"Wu","year":"2020","journal-title":"JAMA"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1001\/jamaneurol.2020.1127","article-title":"Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China","volume":"77","author":"Mao","year":"2020","journal-title":"JAMA Neurol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1016\/S2468-1253(20)30057-1","article-title":"Liver injury in COVID-19: management and challenges","volume":"5","author":"Zhang","year":"2020","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/S1473-3099(20)30180-8","article-title":"COVID-19, a pandemic or not?","volume":"20","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/j.dsx.2020.04.044","article-title":"Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis","volume":"14","author":"Kumar","year":"2020","journal-title":"Diabetes Metab Syndr"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1001\/jamacardio.2020.1017","article-title":"Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19)","volume":"5","author":"Guo","year":"2020","journal-title":"JAMA Cardiol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"828402","DOI":"10.3389\/fmed.2022.828402","article-title":"Comparison of SARS-CoV-2 variants of concern alpha (B.1.1.7) vs. Beta (B.1.351) in critically ill patients: a multicenter cohort study","volume":"9","author":"Louis","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1016\/S1473-3099(22)00129-3","article-title":"Neutralisation sensitivity of the SARS-CoV-2 omicron (B.1.1.529) variant: a cross-sectional study","volume":"22","author":"Sheward","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e589","DOI":"10.1002\/mco2.589","article-title":"Antigenicity and infectivity of severe acute respiratory syndrome coronavirus 2 omicron subvariants EG.5.1, XBB.2.3, FL.1.5.1, and BA.2.86","volume":"5","author":"Tang","year":"2020","journal-title":"MedComm"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"18","DOI":"10.3969\/j.issn.1007-8134.2023.01.02","article-title":"Guideline on diagnosis and treatment of novel coronavirus pneumonia (interim 10th edition)","volume":"36","year":"2023","journal-title":"Infect Dis Info"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1016\/S0140-6736(22)01586-0","article-title":"Real-world effectiveness of molnupiravir and nirmatrelvir plus ritonavir against mortality, hospitalisation, and in-hospital outcomes among community-dwelling, ambulatory patients with confirmed SARS-CoV-2 infection during the omicron wave in Hong Kong: an observational study","volume":"400","author":"Wong","year":"2022","journal-title":"Lancet"},{"key":"ref18","year":"2020"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1775","DOI":"10.1001\/jama.2020.4683","article-title":"Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy","volume":"323","author":"Onder","year":"2020","journal-title":"JAMA"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1038\/s41586-020-2918-0","article-title":"Age-specific mortality and immunity patterns of SARS-CoV-2","volume":"590","author":"O'Driscoll","year":"2021","journal-title":"Nature"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1186\/s12877-022-02837-7","article-title":"Computed tomography findings and prognosis in older COVID-19 patients","volume":"22","author":"Okoye","year":"2022","journal-title":"BMC Geriatr"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e028426","DOI":"10.1136\/bmjopen-2018-028426","article-title":"Socioeconomic determinants of chronic health diseases among older Indian adults: a nationally representative cross-sectional multilevel study","volume":"9","author":"Singh","year":"2019","journal-title":"BMJ Open"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"586","DOI":"10.3389\/fimmu.2018.00586","article-title":"Age and age-related Diseases: role of inflammation triggers and cytokines","volume":"9","author":"Rea","year":"2018","journal-title":"Front Immunol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1016\/S0140-6736(21)02226-1","article-title":"Estimating the early impact of the US COVID-19 vaccination programme on COVID-19 cases, emergency department visits, hospital admissions, and deaths among adults aged 65 years and older: an ecological analysis of national surveillance data","volume":"399","author":"McNamara","year":"2022","journal-title":"Lancet"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1146\/annurev-med-042220-011857","article-title":"COVID-19 and diabetes","volume":"73","author":"Singh","year":"2022","journal-title":"Annu Rev Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1016\/S1473-3099(23)00299-2","article-title":"Outpatient treatment of COVID-19 and incidence of post-COVID-19 condition over 10 months (COVID-OUT): a multicentre, randomised, quadruple-blind, parallel-group, phase 3 trial","volume":"23","author":"Bramante","year":"2023","journal-title":"Lancet Infect Dis"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1056\/NEJMoa2201662","article-title":"Randomized trial of metformin, Ivermectin, and fluvoxamine for Covid-19","volume":"387","author":"Bramante","year":"2022","journal-title":"N Engl J Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1186\/s12879-021-06585-8","article-title":"Clinical characteristics and risk factors of fatal patients with COVID-19: a retrospective cohort study in Wuhan, China","volume":"21","author":"Jin","year":"2021","journal-title":"BMC Infect Dis"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.kint.2020.04.031","article-title":"COVID-19: clinical course and outcomes of 36 hemodialysis patients in Spain","volume":"98","author":"Goicoechea","year":"2020","journal-title":"Kidney Int"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1372","DOI":"10.1164\/rccm.202003-0543OC","article-title":"Clinical features of 85 fatal cases of COVID-19 from Wuhan. A retrospective observational study","volume":"201","author":"Du","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1038\/s41577-020-0308-3","article-title":"COVID-19: immunopathology and its implications for therapy","volume":"20","author":"Cao","year":"2020","journal-title":"Nat Rev Immunol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1093\/cid\/ciaa272","article-title":"Clinical features of 69 cases with coronavirus disease 2019 in Wuhan, China","volume":"71","author":"Wang","year":"2020","journal-title":"Clin Infect Dis"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"n436","DOI":"10.1136\/bmj.n436","article-title":"Severe covid-19 pneumonia: pathogenesis and clinical management","volume":"372","author":"Attaway","year":"2021","journal-title":"BMJ"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"2742","DOI":"10.1002\/jmv.26174","article-title":"Clinical characteristics of COVID-19 in patients with preexisting ILD: a retrospective study in a single center in Wuhan, China","volume":"92","author":"Huang","year":"2020","journal-title":"J Med Virol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"105954","DOI":"10.1016\/j.ijantimicag.2020.105954","article-title":"Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality","volume":"55","author":"Zhang","year":"2020","journal-title":"Int J Antimicrob Agents"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1126\/science.abb8925","article-title":"Cytokine release syndrome in severe COVID-19","volume":"368","author":"Moore","year":"2020","journal-title":"Science"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1016\/j.immuni.2020.04.003","article-title":"COVID-19: a new virus, but a familiar receptor and cytokine release syndrome","volume":"52","author":"Hirano","year":"2020","journal-title":"Immunity"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"102702","DOI":"10.1016\/j.bjid.2022.102702","article-title":"Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value: a retrospective study","volume":"26","author":"Vivan","year":"2022","journal-title":"Braz J Infect Dis"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"2018598","DOI":"10.1155\/2019\/2018598","article-title":"Age- and sex-specific reference intervals for myocardial enzyme activity in healthy Chinese Han population aged 1\u223c<18 years","volume":"2019","author":"Guo","year":"2019","journal-title":"Biomed Res Int"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1111\/j.1749-6632.2000.tb06651.x","article-title":"An evolutionary perspective on immunosenescence","volume":"908","author":"Franceschi","year":"2000","journal-title":"Ann N Y Acad Sci"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1861","DOI":"10.1056\/NEJMc2005203","article-title":"Clinical characteristics of Covid-19 in China","volume":"382","author":"Guan","year":"2020","journal-title":"Reply N Engl J Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.amjmed.2008.08.033","article-title":"Relationship of ethnic origin, gender, and age to blood creatine kinase levels","volume":"122","author":"Neal","year":"2009","journal-title":"Am J Med"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"362","DOI":"10.13406\/j.cnki.cyxb.003034","article-title":"Rhabdomyolysis with pericardial tamponade and myocardial hypertrophy in a child:a case report","volume":"48","author":"Li","year":"2023","journal-title":"J Chongqing Medical University"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1053\/j.ajkd.2020.09.003","article-title":"Leaf DE; STOP-COVID investigators. Characteristics and outcomes of individuals with pre-existing kidney disease and COVID-19 admitted to intensive care units in the United States","volume":"77","author":"Flythe","year":"2021","journal-title":"Am J Kidney Dis"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"5540","DOI":"10.3390\/ijms24065540","article-title":"Secretory phospholipase A2 and Interleukin-6 levels as predictive markers of the severity and outcome of patients with COVID-19 infections","volume":"24","author":"Urazov","year":"2023","journal-title":"Int J Mol Sci"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1016\/j.kint.2020.03.001","article-title":"The novel coronavirus 2019 epidemic and kidneys","volume":"97","author":"Naicker","year":"2020","journal-title":"Kidney Int"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1111\/ajt.16424","article-title":"Is COVID-19 infection more severe in kidney transplant recipients?","volume":"21","author":"Caillard","year":"2021","journal-title":"Am J Transplant"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/j.kint.2020.10.032","article-title":"Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring","volume":"99","author":"Waldman","year":"2021","journal-title":"Kidney Int"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1111\/sdi.12995","article-title":"Risk factors for the mortality of hemodialysis patients with COVID-19: a multicenter study from the overall hemodialysis population in Wuhan","volume":"35","author":"Tang","year":"2022","journal-title":"Semin Dial"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"699243","DOI":"10.3389\/fmed.2021.699243","article-title":"Development of an early warning model for predicting the death risk of coronavirus disease 2019 based on data immediately available on admission","volume":"8","author":"Wang","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1038\/s41581-020-00357-4","article-title":"Immunity, endothelial injury and complement-induced coagulopathy in COVID-19","volume":"17","author":"Perico","year":"2021","journal-title":"Nat Rev Nephrol"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"753035","DOI":"10.3389\/fmed.2021.753035","article-title":"Predictors of mortality in hospitalized COVID-19 patients complicated with hypotension and hypoxemia: a retrospective cohort study","volume":"8","author":"Sun","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1016\/S2213-2600(20)30370-2","article-title":"Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. Lancet","volume":"8","author":"Grasselli","year":"2020","journal-title":"Respir Med"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1424720\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T04:38:17Z","timestamp":1728362297000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1424720\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,8]]},"references-count":56,"alternative-id":["10.3389\/fpubh.2024.1424720"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1424720","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,8]]},"article-number":"1424720"}}