Admission vital signs as predictors of COVID-19 mortality: a retrospective cross-sectional study
Abstract Background COVID-19 remains a major healthcare concern. Vital signs are routinely measured on admission and may provide an early, cost-effective indicator of outcome – more so in developing countries where such data is scarce. We sought to describe the association between six routinely meas...
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | BMC Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12873-022-00631-7 |
| _version_ | 1818264224362659840 |
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| author | Ahmed Sameer Ikram Somasundram Pillay |
| author_facet | Ahmed Sameer Ikram Somasundram Pillay |
| author_sort | Ahmed Sameer Ikram |
| collection | DOAJ |
| description | Abstract Background COVID-19 remains a major healthcare concern. Vital signs are routinely measured on admission and may provide an early, cost-effective indicator of outcome – more so in developing countries where such data is scarce. We sought to describe the association between six routinely measured admission vital signs and COVID-19 mortality, and secondarily to derive potential applications for resource-limited settings. Methods Retrospective analysis of consecutive patients admitted to King Edward VIII Hospital, South Africa, with COVID-19 during June–September 2020 was undertaken. The sample was subdivided into survivors and non-survivors and comparisons made in terms of demographics and admission vital signs. Univariate and multivariate analysis of predictor variables identified associations with in-hospital mortality, with the resulting multivariate regression model evaluated for its predictive ability with receiver operating characteristic (ROC) curve analysis. Results The 236 participants enrolled comprised 153(77.54%) survivors and 53(22.46%) non-survivors. Most participants were Black African(87.71%) and female(59.75%) with a mean age of 53.08(16.96) years. The non-survivor group demonstrated a significantly lower median/mean for admission oxygen saturation (%) [87(78–95) vs. 96(90–98)] and diastolic BP (mmHg) [70.79(14.66) vs. 76.3(12.07)], and higher median for admission respiratory rate (breaths/minute) [24(20–28) vs. 20(20–23)] and glucose (mmol/l) [10.2(6.95–16.25) vs. 7.4(5.5–9.8)]. Age, oxygen saturation, respiratory rate, glucose and diastolic BP were found to be significantly associated with mortality on univariate analysis. A log rank test revealed significantly lower survival rates in patients with an admission oxygen saturation < 90% compared with ≥90% (p = 0.001). Multivariate logistic regression revealed a significant relationship between age and oxygen saturation with in-hospital mortality (OR 1.047; 95% CI 1.016–1.080; p = 0.003 and OR 0.922; 95% CI 0.880–0.965; p = 0.001 respectively). A ROC curve analysis generated an area under the curve (AUC) of 0.778 (p < 0.001) when evaluating the predictive ability of oxygen saturation, respiratory rate, glucose and diastolic BP for in-hospital death. This improved to an AUC of 0.832 (p < 0.001) with the inclusion of age. Conclusion A multivariate regression model comprising admission oxygen saturation, respiratory rate, glucose and diastolic BP (with/without age) demonstrated promising predictive capacity, and may provide a cost-effective means for early prognostication of patients admitted with COVID-19 in resource-limited settings. |
| first_indexed | 2024-12-12T19:31:31Z |
| format | Article |
| id | doaj.art-17c77bb46fbe413fb471c736fd26963d |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-12-12T19:31:31Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-17c77bb46fbe413fb471c736fd26963d2022-12-22T00:14:24ZengBMCBMC Emergency Medicine1471-227X2022-04-0122111010.1186/s12873-022-00631-7Admission vital signs as predictors of COVID-19 mortality: a retrospective cross-sectional studyAhmed Sameer Ikram0Somasundram Pillay1King Edward VIII HospitalLecturer Nelson R Mandela School of Clinical Medicine, King Edward VIII HospitalAbstract Background COVID-19 remains a major healthcare concern. Vital signs are routinely measured on admission and may provide an early, cost-effective indicator of outcome – more so in developing countries where such data is scarce. We sought to describe the association between six routinely measured admission vital signs and COVID-19 mortality, and secondarily to derive potential applications for resource-limited settings. Methods Retrospective analysis of consecutive patients admitted to King Edward VIII Hospital, South Africa, with COVID-19 during June–September 2020 was undertaken. The sample was subdivided into survivors and non-survivors and comparisons made in terms of demographics and admission vital signs. Univariate and multivariate analysis of predictor variables identified associations with in-hospital mortality, with the resulting multivariate regression model evaluated for its predictive ability with receiver operating characteristic (ROC) curve analysis. Results The 236 participants enrolled comprised 153(77.54%) survivors and 53(22.46%) non-survivors. Most participants were Black African(87.71%) and female(59.75%) with a mean age of 53.08(16.96) years. The non-survivor group demonstrated a significantly lower median/mean for admission oxygen saturation (%) [87(78–95) vs. 96(90–98)] and diastolic BP (mmHg) [70.79(14.66) vs. 76.3(12.07)], and higher median for admission respiratory rate (breaths/minute) [24(20–28) vs. 20(20–23)] and glucose (mmol/l) [10.2(6.95–16.25) vs. 7.4(5.5–9.8)]. Age, oxygen saturation, respiratory rate, glucose and diastolic BP were found to be significantly associated with mortality on univariate analysis. A log rank test revealed significantly lower survival rates in patients with an admission oxygen saturation < 90% compared with ≥90% (p = 0.001). Multivariate logistic regression revealed a significant relationship between age and oxygen saturation with in-hospital mortality (OR 1.047; 95% CI 1.016–1.080; p = 0.003 and OR 0.922; 95% CI 0.880–0.965; p = 0.001 respectively). A ROC curve analysis generated an area under the curve (AUC) of 0.778 (p < 0.001) when evaluating the predictive ability of oxygen saturation, respiratory rate, glucose and diastolic BP for in-hospital death. This improved to an AUC of 0.832 (p < 0.001) with the inclusion of age. Conclusion A multivariate regression model comprising admission oxygen saturation, respiratory rate, glucose and diastolic BP (with/without age) demonstrated promising predictive capacity, and may provide a cost-effective means for early prognostication of patients admitted with COVID-19 in resource-limited settings.https://doi.org/10.1186/s12873-022-00631-7COVID-19Vital signsOxygen saturationRespiratory rateBlood pressureHeart rate |
| spellingShingle | Ahmed Sameer Ikram Somasundram Pillay Admission vital signs as predictors of COVID-19 mortality: a retrospective cross-sectional study BMC Emergency Medicine COVID-19 Vital signs Oxygen saturation Respiratory rate Blood pressure Heart rate |
| title | Admission vital signs as predictors of COVID-19 mortality: a retrospective cross-sectional study |
| title_full | Admission vital signs as predictors of COVID-19 mortality: a retrospective cross-sectional study |
| title_fullStr | Admission vital signs as predictors of COVID-19 mortality: a retrospective cross-sectional study |
| title_full_unstemmed | Admission vital signs as predictors of COVID-19 mortality: a retrospective cross-sectional study |
| title_short | Admission vital signs as predictors of COVID-19 mortality: a retrospective cross-sectional study |
| title_sort | admission vital signs as predictors of covid 19 mortality a retrospective cross sectional study |
| topic | COVID-19 Vital signs Oxygen saturation Respiratory rate Blood pressure Heart rate |
| url | https://doi.org/10.1186/s12873-022-00631-7 |
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