Discussion
Although COVID-2019 is one of the most emergency infections today, there
are limited data on risk factors of outcome. In our study of patients
with COVID-19 in Harbin we have shown that 16.35% have developed of
severe COVID-2019 and the percent of poor outcome was 10.58% (the
mortality was 2.88%, and the percent of ICU admission or transfer to a
superior hospital was 7.69%). Both are lower than the previous research
which showed that 26% of patients received ICU care, and mortality was
4.3% in Wuhan 7. The lower mortality may be related
to early isolation and early treatment in Harbin. ECG abnormalities and
overweight are predictors of severe COVID-2019. On multivariate
analysis, presence of abnormal ECG on admission and higher BMI are the
two significant factors predicting outcome. The percent of poor outcomes
increases with abnormal electrocardiogram.
Early identification of those “at risk” of poor outcome is an
essential part of the assessment of any disease. In the study, the data
of 104 patients with COVID-2019 are analyzed, the baseline
characteristics of patients in the non-severe and severe groups are
described and compared. The independent risk factors affecting incidence
of severe illness are screened by univariate and multivariate Logistic
Regression. We found that ECG abnormalities and overweight plays a key
role in determining the course in severe patients with COVID-2019.
A recent study showed myocardial injury is significantly associated with
fatal outcome of COVID-19, while myocardial injury is associated with
cardiac dysfunction and arrhythmias 8. It is similar
with our study. In our study, creatine kinase and creatine kinase MB
form and ECG record were compared and used to univariate logistic
regression evaluating. Neither creatine kinase nor creatine kinase MB
form is associated with developing severe COVID-19. However, ECG
abnormalities is associated with the outcome. This is also similar to
the observation in patients with sepsis, where the heart rate
variability which calculated by electrocardiogram recording seemed to be
the best indicator to predict the occurrence of septic shock9 or mortality 10.
Another research showed is neutrophil-to-lymphocyte ratio is an
independent risk factor for mortality in hospitalized patients with
COVID-19 11. In that research focused on a series of
predictors such as age, gender, symptoms and blood laboratory findings,
except BMI and ECG results. However, in other publications evaluating
the BMI was a predictor of microbiological persistence in patients with
mycobacterium avium complex lung disease 12. The virus
persistence in respiratory might imply a lymphoid hypertrophy and a
stimulatory effect for inflammation 13. Virus
persistence may have a pathogenetic potential for development of
lymphoid hypertrophy and a chronic stimulatory effect for inflammation.
In this study, we first quantify the total direct economic burden of
COVID-2019 related hospitalizations. Because of the high spread of the
disease, all patents were hospitalized. The median cost per patient is
¥11805.98 and higher in severe patients. The medical costs per patient
of COVID-2019 in Harbin is higher than influenza hospitalisation costs
of ¥9832.00 in China 14, but lower than that of
The limitations of our study is a single center study and the small
sample size. In addition, the laboratory test of cardiac function
examination, including Troponin I and brain natriuretic peptide, cannot
be acquired in the medical records. Third, the medical costs data has
been obtained from a middle city, which may not be applicable to the
other city or country.