The Role of Risk Factors in the Outcome Measurements in Patients Diagnosed with COVID-19

Clinical Question 

Since the outbreak of COVID-19 in December 2018, occurrence of the disease has spread rapidly, with over 32 million reported cases ( Cheng et al., 2020) . My group's focus was the analysis published research on the role of risk factors in the outcome measurements in patients diagnosed with the virus. While diagnosing COVID-19, risk factors play a central part in the pandemic's prevention and mortality prediction. Even though coronavirus manifestation is through acute respiratory failure and alveolar damage, the involvement of other risk factors such as acute kidney injury and obesity needs to be explored. According to a study conducted by Cheng et al. (2020) on 701 COVID-19 positive patients in Wuhan, the prevalence of elevated blood urea was 13.1%. Other kidney risk factors, such as glomerular filtrate under 60ml/min/73m2, had a 14% prevalence within the same sample population. During the study period, acute kidney injury occurred in 5% of patients within the study population. After adjusting sex, age and severity, and leukocyte count, Cox proportional hazard regression confirmed that elevated blood urea nitrogen were independent factors for hospital coronavirus deaths. The Center for Disease Control also listed severe obesity as a high-risk factor in the virus's prevalence. Therefore, this paper analyses the role of risk factors –obesity and kidney disease, in the outcome measurement in patients diagnosed with coronavirus. 

Evidence Matrix Table: Data Summary (Appendix A) 

Description of Findings 

From the study conducted by Cheng et al. (2020) on the association of kidney disease and in-hospital death of patients with COVID-19, the independent variable was kidney disease. Even though the variable was different from the study conducted by Tartof et al. (2020) both had the same dependent variable –COVID-19. Acute kidney injuries caused over 20% more in-hospital deaths than healthy kidney patients. While obese patients with the virus were also likely to die from the virus, their mortality rate was higher. According to the results from the study, patients with high BMI values were four times at risk of dying of the virus than patients with low BMI values. 

Both journals used quantitative research study design. The procedure used in the study of the relationship between BMI values and coronavirus started with a retrospective cohort study of individuals diagnosed with the virus for 31 days. It excluded pregnant women since their BMI measurements were not comparable. The primary exposure interest was then subcategorized into underweight, normal, overweight, and obese classes I – III, with class III being extremely obese patients. Based on the sample size and the trend of association between obesity and the virus in other cities, the research's confidence level was 95%. On the other hand, the procedure used to analyze the relationship between COVID-19 and kidney disease began with clinical diagnosis criteria of fever and respiratory symptoms, lymphopenia, and results from tomographic scans to diagnose lung abnormalities ( Cheng et al., 2020) . Pediatric patients were excluded. The confidence levels of the research were 60% according to the sample size and data collected. Participants in both studies were COVID-19 positive patients with restriction of pregnant patients in BMI research while children in the kidney research. Whereas the instrument used in the kidney research was the cox proportional hazard regression, the research on BMI used Fisher exact test. The Cox regression model is reliable in investigating associations between patient's survival time and one predictor variable. 

The research conducted by Tartof et al. (2020) used the Fischer exact test to measure covariates and the Kruskal-Wallis test in bivariates analysis. These results were reliable in estimating the number of patients who survived against those that died. During our research, two questions guided our study: What is the role of risk factors such as kidney and obesity in outcome measurements of patients with COVID-19, and what are the impact of these factors on the mortality rate? 

Obesity and Kidney disease are risk factors that increase the death rate of patients with COVID-19. During the study, acute kidney injury occurred in 5.1% patients, and results from Cox proportional regression analysis confirmed that these patients had a significantly higher risk of death. After covariate analysis, results also indicated that patients with high BMI were more likely to die of the virus than healthy patients. Therefore, this evidence affirms that risk factors impact the outcome measurement of patients with COVID-19. 

References 

Cheng, Y., Luo, R., Wang, K., Zhang, M., Wang, Z., Dong, L., ... & Xu, G. (2020). Kidney disease is associated with in-hospital death of patients with COVID-19.  Kidney international . 

Tartof, S. Y., Qian, L., Hong, V., Wei, R., Nadjafi, R. F., Fischer, H., ... & Saxena, T. (2020). Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization.  Annals of internal medicine .