The enrolled patients were separated into survivors and non-survivors based on clinical outcomes, and demographics and baseline characteristics for each group are provided in Table 1. A total of 262 patients aged above 18 were admitted to the study, which included 244 survivors and 18 non-survivors. Based on their age, patients were further divided into three groups, i.e., ≥ 65years (21.4%), 45 years ≤ age < 65years (36.6%), < 45years (42.0%), respectively. Comparing the survivors with the non-survivors, there were significant differences that among in the ages and comorbidities with cancer (P < 0.05).
Table 1 Demographics and baseline characteristics of survivor and non-survivor of COVID-19 patients
|
No. (%)
Total (n = 262)
|
Survivor
(n = 244)
|
Non-survivor
(n = 18)
|
P value
|
Age, %
≥65y
45≤age<65
<45y
|
56(21.4)
96(36.6)
110(42.0)
|
45(18.4)
89(36.5)
110(45.1)
|
11(61.1)
7(38.9)
0(0.0)
|
<0.001
|
Gender, %
Male
Female
|
137(52.3)
125(47.7)
|
127(52.0)
117(48.0)
|
10(55.6)
8(44.4)
|
0.774
|
Symptoms
|
|
|
|
|
Fever, %
|
181(78.6)
|
165(67.6)
|
16(88.9)
|
0.060
|
Cough, %
|
212(80.9)
|
197(80.7)
|
15(83.3)
|
0.787
|
Myalgia, %
|
26(9.9)
|
25(10.2)
|
1(5.6)
|
0.521
|
Fatigue, %
|
114(43.5)
|
109(44.7)
|
5(27.8)
|
0.164
|
Headache, %
|
33(12.6)
|
32(13.1)
|
1(5.6)
|
0.352
|
Diarrhoea, %
|
58(22.1)
|
54(22.1)
|
4(22.2)
|
0.993
|
Abdominal pain, %
|
7(2.7)
|
7(2.9)
|
0(0.0)
|
0.467
|
Shortness of breath, %
|
90(34.3)
|
83(34.0)
|
7(38.9)
|
0.675
|
Comorbidities
|
|
|
|
|
Hypertension, %
|
53(20.2)
|
48(19.7)
|
5(27.8)
|
0.410
|
Cardiovascular disease, %
|
18(6.9)
|
15(6.1)
|
3(16.7)
|
0.089
|
Diabetes, %
|
25(9.5)
|
23(9.4)
|
2(11.1)
|
0.815
|
COPD, %
|
1(0.0)
|
1(0.0)
|
0(0.0)
|
0.786
|
Chronic bronchitis, %
|
20(7.6)
|
20(8.1)
|
0(0.0)
|
0.527
|
Cerebrovascular disease, %
|
9(3.4)
|
8(3.2)
|
1(5.5)
|
0.609
|
Cancer, %
|
5(1.9)
|
2(1.0)
|
3(16.7)
|
<0.001
|
Abbreviation: COVID-19, Coronavirus disease 2019; COPD, chronic obstructive pulmonary disease.
P values indicate differences between survivor and non- survivor of COVID-19 patients. P< 0.05 was considered statistically significant.
The non-survivor COVID-19 patients had significantly higher white blood cells (WBC) (4.7 vs. 13.0 ×109/L; P<0.001), neutrophils (3.0 vs. 11.6 ×109/L; P<0.001), C-reactive proteins (CRP) (15.7 vs. 76.7mg/L; P<0.001), and TG/HDL-c ratio (1.4 vs. 2.5; P=0.001) levels than survivors, but the levels of lymphocytes (1.1 vs. 0.6 ×109/L; P<0.001), and low density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio (LDL-c/HDL-c) (3.2 vs. 2.2; P=0.010) were lower than non-survivors when compared with survivors (Table 2).
Table 2 Comparison of laboratory parameters between the survivor and non-survivor of COVID-19 patients
|
Normal range
|
Survivor
|
Non-survivor
|
P value
|
WBC, ×109/L
|
3.5-9.5
|
4.7(3.6-6.0)
|
13.0(7.8-17.8)
|
<0.001
|
Lymphocytes, ×109/L
|
0.8-4.0
|
1.1(0.8-1.5)
|
0.6(0.4-0.7)
|
<0.001
|
Neutrophils, ×109/L
|
1.8-6.3
|
3.0(2.2-3.8)
|
11.6(6.9-16.6)
|
<0.001
|
CRP, mg/L
|
0-8
|
15.7(4.5-35.3)
|
76.7(36.8-229.0)
|
<0.001
|
TC/HDL-c ratio
|
/
|
4.5(3.8-5.6)
|
5.0(3.4-5.6)
|
0.899
|
LDL-c/HDL-c ratio
|
/
|
3.2(2.5-4.1)
|
2.2(1.4-3.4)
|
0.010
|
TG/HDL-c ratio
|
/
|
1.4(0.9-2.1)
|
2.5(1.5-4.8)
|
0.001
|
Abbreviation: COVID-19, Coronavirus disease 2019; WBC, white blood cells; CRP, C-reactive proteins; TC/HDL-c ratio, total cholesterol-to-high-density lipoprotein cholesterol ratio; LDL-c/HDL-c ratio, low-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio; TG/HDL-c ratio, triglyceride-to-high-density lipoprotein cholesterol ratio.
P values indicate differences between smoking and non-smoking COVID-19 patients. P<0.05 was considered statistically significant.
The mortality of COVID-19 patients was associated with age [odds ratio (OR) = 1.108; 95% confidence interval (CI), 1.060-1.159; P < 0.001], cancer (OR = 24.200; 95% CI, 3.754-156.023; P = 0.001), WBC (OR = 1.451; 95%CI, 1.267-1.661; P < 0.001), lymphocytes (OR = 0.006; 95% CI, 0.001-0.059; P < 0.001), neutrophils (OR = 1.493; 95% CI, 1.294-1.724; P < 0.001), CRP (OR = 1.023; 95% CI, 1.014-1.032; P < 0.001), LDL-c/HDL-c ratio (OR = 0.551; 95% CI, 0.327-0.927; P = 0.025), and TG/HDL-c ratio (OR = 1.291; 95% CI, 1.066-1.564; P = 0.009) (Table 3). However, only TG/HDL-c ratio (OR = 1.730; 95% CI, 1.044-2.866; P = 0.033) and cancer (OR = 44.973; 95% CI, 2.059-982.524; P = 0.016) were the independent risk factors affected mortality in COVID-19 patients (Table 4).
Table 3 Univariate analysis of risk factors related to the mortality of COVID-19 patients
Variables
|
Odds Ratio (95% CI)
|
P value
|
Age
|
1.108(1.060-1.159)
|
<0.001
|
Cancer
|
24.200(3.754-156.023)
|
0.001
|
WBC
|
1.451(1.267-1.661)
|
<0.001
|
Lymphocytes
|
0.006(0.001-0.059)
|
<0.001
|
Neutrophils
|
1.493(1.294-1.724)
|
<0.001
|
CRP
|
1.023(1.014-1.032)
|
<0.001
|
LDL-c/HDL-c ratio
|
0.551(0.327-0.927)
|
0.025
|
TG/HDL-c ratio
|
1.291(1.066-1.564)
|
0.009
|
Abbreviation: COVID-19, Coronavirus disease 19; CI, confidence interval; WBC, white blood cells; CRP, C-reactive proteins; LDL-c/HDL-c ratio, low-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio; TG/HDL-c ratio, triglyceride-to-high-density lipoprotein cholesterol ratio.
P values indicate differences between the survivor and non-survivor COVID-19 patients. P < 0.05 was considered statistically significant.
Table 4 Multivariate analysis of risk factors related to the mortality of COVID-19 patients
|
B
|
SE
|
Wald
|
P
|
OR
|
95% CI
|
Age
|
0.050
|
0.039
|
1.703
|
0.192
|
1.052
|
0.975-1.134
|
Cancer
|
3.806
|
1.574
|
5.851
|
0.016
|
44.973
|
2.059-982.524
|
WBC
|
0.919
|
1.322
|
0.484
|
0.487
|
0.399
|
0.030-5.319
|
Lymphocytes
|
3.388
|
2.375
|
2.035
|
0.154
|
0.034
|
0.000-3.550
|
Neutrophils
|
1.055
|
1.358
|
0.604
|
0.437
|
2.872
|
0.201-41.096
|
CRP
|
0.007
|
0.007
|
1.113
|
0.292
|
1.007
|
0.994-1.021
|
LDL-c/HDL-c ratio
|
0.323
|
0.307
|
1.111
|
0.292
|
0.724
|
0.397-1.321
|
TG/HDL-c ratio
|
0.548
|
0.258
|
4.522
|
0.033
|
1.730
|
1.044-2.866
|
Abbreviation: COVID-19, Coronavirus disease 19; CI, confidence interval; WBC, white blood cells; CRP, C-reactive proteins; LDL-c/HDL-c ratio, low-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio; TG/HDL-c ratio, triglyceride-to-high-density lipoprotein cholesterol ratio.
P values indicate differences between the survivor and non-survivor COVID-19 patients. P < 0.05 was considered statistically significant.
ROC analysis indicated that the TG/HDL-c ratio was able to significantly predict death in COVID-19 patients (P = 0.001), and the area under the curve (AUC) was 0.731 (95%CI, 0.609-0.853) with sensitivity and specificity of 0.722 and 0.656, respectively. (Figure 1) Moreover, bivariate correlations indicated that TG/HDL-c ratio positively correlated with WBC (r = 0.255, P<0.001), neutrophils (r = 0.243, P < 0.001) and CRP (r = 0.170, P < 0.006), but no significant correlations existed between TG/HDL-c ratio and lymphocytes (r = -0.004, P = 0.949).