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

Variable n (%) or median (IQR)	All patients n = 286	Moderate n = 134	Severe n = 152	P	Survived n = 268	Did not survive n = 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

[i] COPD, chronic obstructive pulmonary disease; COVID-19, coronavirus disease-2019; IQR, interquartile range.

Table 2

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

Variable, median (IQR)	Total	Disease severity			Mortality
Admission data	Total	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

* P < 0.05;

** P < 0.01;

*** P < 0.001.

ALK-p, alkaline phosphatase; AST, aspartate aminotransferase; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; IQR, interquartile range; LDH, lactate dehydrogenase; P-LCR, platelet larger cell ratio; RBC, red blood cell; RDW, RBC distribution width; RDW-CV, RBC distribution width – coefficient of variation; RDW-SD, RBC distribution width – standard deviation; SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2.

Table 3

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

Variable	Severity			Mortality
Variable	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

* P < 0.05;

** P < 0.01;

*** P < 0.001.

ALK-p, alkaline phosphatase; AST, aspartate aminotransferase; COVID-19, coronavirus disease-2019; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; IQR, interquartile range; LDH, lactate dehydrogenase; OR, odds ratio; P-LCR, platelet larger cell ratio; RBC, red blood cell; RDW-CV, RBC distribution width – coefficient of variation; RDW-SD, RBC distribution width – standard deviation.

Table 4

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^*

* P < 0.05;

** P < 0.01;

*** P < 0.001.

B, logistic regression coefficient (β); CI, confidence interval; COVID-19, coronavirus disease-2019; OR, odds ratio; RBC, red blood cell; RDW-CV, RBC distribution width – coefficient of variation; SE, standard error for the unstandardized β.

Table 5

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^*

* P < 0.05;

** P < 0.01;

*** P < 0.001.

B, logistic regression coefficient (β); CI, confidence interval; COVID-19, coronavirus disease-2019; OR, odds ratio; P-LCR, platelet larger cell ratio; RBC, red blood cell; SE, standard error for the unstandardized β.

Table 6

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

* P < 0.05;

** P < 0.01;

*** P < 0.001.

AUC, area under the curve; CI, confidence interval; COVID-19, coronavirus disease-2019; CRP, C-reactive protein; LDH, lactate dehydrogenase; RDW-SD, red blood cell distribution width – standard deviation; ROC, receiver operating characteristic.

References

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Articles in this issue

DOI: https://doi.org/10.2478/abm-2022-0005 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415

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Language: English

Page range: 31 - 42

Published on: Feb 28, 2022

Published by: Chulalongkorn University

In partnership with: Paradigm Publishing Services

Keywords:

COVID-19,

clinical decision-making,

clinical laboratory techniques,

Iran,

pneumonia

Related subjects:

Medicine,

Assistive professions, nursing,

Basic medical science,

Basic medical science, other,

Clinical medicine,

Clinical medicine, other

© 2022 Zahra Naderi Beni, Afsaneh Naderi Beni, Fereidoun Rahmani Samani, Mohammad Ali Dayani, Fariba Naderi Beni, Hamed Radmehr, Pegah Noorshargh, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 16 (2022): Issue 1 (February 2022)

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

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