Predictors of severe course and mortality in patients with COVID-19 associated pneumonia.

EU statistics report that the mortality rate from COVID-19 to the end of August 2021 was about 65 % higher in Bulgaria than the average across EU countries (approximately 2 695 per million population compared with about 1 590 for the EU average). The study is aimed at elucidating predictors of severe course and morality in patients with COVID-19–associated pneumonia. It includes 306 patients, treated at the Clinics of Pneumology, St. George University Hospital in Plovdiv from August 2020 to April 2021. A panel of demographic, healthcare related, clinical, laboratory and X ray imaging parameters were investigated and associations with mortality analyzed, using descriptive statistics, parametrical and non- parametrical methods. Comorbid pre-existing conditions were included in the analysis as well. Patients were assigned in 3 groups - with mild (3.9%), moderate (48.7 %) and severe and critical course (47.4%) Overall mortality was 10.5%. Rates did not show statistically significant differences in men and women and in different age groups (p=0.125 and p=0.55). Duration of stay and time to hospitalization also did not affect lethal outcomes (p=0.40 and p=0.43). In re-hospitalized patients, mortality was 11.6 %, the difference being statistically significant (p=0.034). Breathlessness on admission is the only symptom that is associated with higher mortality (16.1%, p=0.002). Elevated d- dimers, ferritin and p02<50 mmHg, also indicate higher risk of lethal outcome (13.3%, p=0.015, 13.3% p=0.001 and 19.4%, p=0.006). Mortality is higher in patients with cardiovascular (13.7, p=0.003) and pulmonary disorders (23.1%p=0.003) as well as in diabetics (17.5%, p=0.017).