Analysis of the clinical characteristics of patients with COVID-19-related deaths during the two epidemic periods in a tertiary hospital in Wuhan, China: A retrospective study

The coronavirus disease 2019 (COVID-19) pandemic has triggered a global health crisis, resulting in millions of deaths and exacerbating the burden on healthcare systems. This study analyzed the clinical characteristics of hospitalized COVID-19 patients who died during 2 epidemic periods dominated by the Alpha and Omicron variants in a tertiary hospital in Wuhan, to provide evidence for understanding the effects of different variants of the novel coronavirus and the factors contributing to early death. A retrospective analysis was conducted on 164 COVID-19 in-hospital death cases from January to April 2020 and October 2022 to January 2023. Patients were grouped by epidemic period and death status (early death was defined as death within 28 days after symptom onset), with clinical features compared and early death risk factors explored. Among 164 patients, the mean age was 85.76 years, the male-to-female ratio was 3.69:1, and 152 (92.68%) had comorbidities (hypertension, coronary heart disease, diabetes, cerebrovascular disease, chronic renal insufficiency). The median time from onset to admission was 5.00 days, hospital stay was 12.50 days, and onset to death was 18.00 days; 134 (81.71%) died early. Significant differences (P < .05) were found in 16 indicators between epidemic periods and in 29 variables between early versus non-early death groups. Multivariable logistic regression identified 5 independent predictors of early death: second epidemic period (odds ratio [OR] = 44.76), coronary heart disease (OR = 38.96), cerebrovascular disease (OR = 24.65), blood urea nitrogen peak > 18 mmol/L (OR = 23.58), and continuous lactate dehydrogenase (LDH) increase (OR = 9.86). Four protective factors were identified: new-onset anemia (OR = 0.01), lymphocyte (LYM) valley 0.5 to 0.8 × 109/L (OR = 0.02), LDH peak 250 to 400 U/L (OR = 0.01), and hemoglobin (Hb) valley 60 to 90 g/L (OR = 0.01). Hospitalized COVID-19 patients who died early were mainly elderly males with comorbidities. Dynamic changes in key biochemical parameters, particularly blood urea nitrogen, LDH, Hb, and LYM count, demonstrated strong predictive value for early mortality. Elevated biochemical markers indicative of uncontrolled systemic inflammation or progressive organ dysfunction were strongly associated with an increased risk of early mortality. In contrast, a moderated, non-exhaustive physiological response, characterized by preserved LYM counts, stable Hb levels, and non-catastrophic LDH elevation, was independently associated with reduced early death risk, suggesting that functional resilience, rather than maximal immune activation or profound depletion, is protective.