Impact and Interaction of Disease Severity and Hospital Preparations Associated with 28-Day Fatality Risk in COVID-19 Hospitalizations: A Retrospective Cohort Study

  OBJECTIVE  To identify the influence factors associated with 28-day fatality among COVID-19 hospitalizations and to analyze the interaction between the disease severity at admission and the use of hospital preparations.

  METHODS  A retrospective review of records from COVID-19 hospitalizations aged 18 to 90 who were admitted to the Jiangsu Province Hospital of Chinese Medicine from December 15, 2022 to January 15, 2023 were conducted. Patients who died or were lost to follow-up within 48 h of admission were excluded. Patients were divided into survival and death groups based on their 28-day fatality status. Descriptive statistics were used to characterize the two groups and multivariate logistic regression models were employed to identify factors influencing 28-day fatality risk. The interaction between the severity of illness at admission and the use of hospital preparations was explored through crossover analysis and hierarchical regression analysis.

  RESULTS  Significant differences were observed between the survival and death groups in terms of severity of illness at admission, hospital preparations usage, steroid therapy, age, platelet count, lactate dehydrogenase levels, and urea (P < 0.05). Crossover analysis and hierarchical logistic regression analysis revealed a significant antagonistic interaction between the severity of illness at admission and the use of hospital formulations both before adjustment(RERI=-20.678, 95%CI: -33.703~-7.652; APAI=-2.301, 95%CI: -4.027~-0.575) and after adjusting for gender, age, clinical characteristics and further adjusting for laboratory parameters (RERI=-5.972, 95%CI: -10.564~-1.380; APAI=-2.205, 95%CI: -4.131~-0.279), and it was an antagonistic interaction both before (SI=0.279, 95%CI: 0.157~0.493) and after adjustment (SI=0.222, 95%CI: 0.095~0.523).

  CONCLUSION  The use of hospital preparations significantly reduces the 28-day fatality risk among COVID-19 hospitalizations and a clear antagonistic interaction was observed between the disease severity at admission and the use of hospital preparations.