Predictive Factors and Impact of Secondary Pulmonary Infection on Mortality in Patients with Hypoxemic COVID-19 Pneumonia: A Retrospective Cohort Study
Sarawut Krongsut¹, Wipasiri Naraphong², Pannaporn Thongsuk³
Affiliation : ¹ Department of Internal Medicine, Faculty of Medicine, Saraburi Hospital, Saraburi, Thailand; ² Boromarajonani College of Nursing, Saraburi, Faculty of Nursing, Praboromarajchanok Institute, Ministry of Public Health, Saraburi, Thailand; ³ Division of Infectious Disease, Department of Internal Medicine, Phichit Hospital, Phichit, Thailand
Background: Secondary pulmonary infection (SPI) is a severe complication in patients with COVID-19.
Objective: To investigate the risk factors, mortality rates, and complications associated with SPI in hypoxemic COVID-19 pneumonia patients.
Materials and Methods: A retrospective cohort study was conducted at Saraburi Hospital, analyzing medical records of 512 hospitalized COVID-19 patients. The Fine-Gray model identified risk factors for SPI.
Results: SPI was diagnosed in 25.4% of hypoxemic COVID-19 pneumonia patients. SPI patients (mean age of 65.9±15.1 years) had higher inflammation biomarkers, increased in-hospital mortality (IHM), and more complications than non-SPI patients. The primary pathogens causing IHM were gram-negative bacteria in 59.23%. Risk factors for SPI included age of 65 years or older (sHR 1.52; 95% CI 1.03 to 2.25; p=0.032), obesity (sHR 1.52; 95% CI 1.04 to 2.23; p=0.028), invasive mechanical ventilation (sHR 2.87; 95% CI 1.64 to 5.02; p<0.001), lactate dehydrogenase (LDH) level of 520 U/L or more (sHR 2.37; 95% CI 1.69 to 3.33; p=0.027), and catheter-related bloodstream infection (sHR 2.74; 95% CI 1.71 to 4.40; p<0.001). SPI patients had an IHM rate of 74.62%. Multivariable analysis showed higher IHM in SPI patients (aOR 5.29; 95% CI 2.70 to 10.36) compared to non-SPI patients.
Conclusion: SPI is a common and harmful complication in hypoxemic COVID-19 pneumonia. Older age, obesity, invasive mechanical ventilation, elevated LDH levels, and catheter-related bloodstream infection are significant risk factors for SPI. Early detection and prevention strategies are crucial to mitigate the short-term consequences of SPI in COVID-19 patients.
Received 6 February 2023 | Revised 26 May 2023 | Accepted 7 June 2023
DOI: 10.35755/jmedassocthai.2023.07.13765
Keywords : COVID-19; Secondary pulmonary infection; Mortality; Risk factors
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