Unveiling the Unexpected: Why Doctors Should Look beyond the Lungs when Predicting COVID-19 Mortality.

Area of Science:

• Nephrology
• Pulmonology
• Infectious Diseases
• Critical Care Medicine

Background:

• Identifying predictors of COVID-19 mortality is crucial for hospitalized patients.
• Comparing the predictive power of pulmonary versus renal parameters is essential for risk stratification.
• Optimizing admission parameters can enhance patient management and outcomes.

Purpose of the Study:

• To determine the best combination of admission parameters for predicting COVID-19 mortality.
• To compare the predictive capacity of pulmonary and renal parameters for COVID-19 mortality.
• To identify optimal predictive parameter combinations across different hospital settings.

Main Methods:

• Retrospective analysis of 619 hospitalized COVID-19 patients (September-December 2020).
• Data collection included laboratory results, comorbidities, chest X-ray (CXR) scores, and SpO2.
• Renal function assessed using RIFLE, KDIGO criteria, and estimated glomerular filtration rate (eGFR).

Main Results:

• Higher radiological scores and deteriorating renal function (AKI&CKD, eGFR) correlated with increased mortality (p<0.01 and p<0.001).
• Renal parameters (AUC=0.8068) showed superior predictive ability for mortality compared to pulmonary parameters (AUC=0.7667).
• Combining renal and pulmonary parameters yielded the highest AUC (0.8813), with optimal combinations identified for EMS, ED, and Internal Medicine.

Conclusions:

• Renal parameters are superior to pulmonary parameters in predicting COVID-19 mortality in hospitalized patients.
• Combining renal and pulmonary factors significantly enhances mortality prediction accuracy.
• Specific parameter combinations are optimal for predicting mortality in Emergency Medical Services, Emergency Department, and Internal Medicine settings.