Determinants of Time to Convalescence among COVID-19 Patients at Millennium COVID-19 Care Center in Ethiopia: A prospective cohort study

Leulseged, Tigist Workneh; Hassen, Ishmael S.; Maru, Endalkachew H.; Zewde, Wuletaw C.; Chamesew, Nigat W.; Yegile, Kalkidan T.; Bayisa, Abdi B.; Jagema, Tariku B.; Admasu, Teketel T.; Edo, Mesay G.; Gurara, Eyosias K.; Hassen, Meseret D.; Menyelshewa, Etsegenet Y.; Abdi, Firaol M.; Tefera, Mahlet B.; Ali, Siham S.

doi:10.1101/2020.10.07.20208413

Cited by 12 publications

(19 citation statements)

References 29 publications

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“…This could be because those patients with cough were in a more severe disease category, which was also found to be a significant determinant of time to clinical improvement. Another study conducted in the Center on determinants of time to convalescence also showed that having symptomatic disease in general is associated with a delayed biochemical recovery 25 .…”

Section: Discussionmentioning

confidence: 95%

Characteristics and outcome profile of Hospitalized African COVID-19 patients: The Ethiopian Context

Leulseged

et al. 2020

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BackgroundThe COVID-19 pandemic seems to have a different picture in Africa; the first case was identified in the continent after it has already caused a significant loss to the rest of the world and the reported number of cases and mortality rate has been low. Understanding the characteristics and outcome of the pandemicin the African setup is therefore crucial.AimTo assess the characteristics and outcome of COVID-19 patients and to identify determinants of the disease outcome among patients admitted to Millennium COVID-19 Care Center in Ethiopia.MethodsA prospective cohort study was conducted among 1345 consecutively admitted RT-PCR confirmed COVID-19 patients from July to September, 2020. Frequency tables, KM plots, median survival times and Log-rank test were used to describe the data and compare survival distribution between groups. Cox proportional hazard survival model was used to identify determinants of time to clinical improvement and the independent variables, where adjusted hazard ratio, P-value and 95% CI for adjusted hazard ratio were used for testing significance and interpretation of results. Binary logistic regression model was used to assess the presence of a statistically significant association between disease outcome and the independent variables, where adjusted odds ratio, P-value and 95% CI for adjusted odds ratio were used for testing significance and interpretation of resultsResultsAmong the study population, 71 (5.3%) died, 72 (5.4%) were transferred and the rest 1202 (89.4%) were clinically improved. The median time to clinical improvement was 14 days. On the multivariable Cox proportional hazard model; temperature (AHR= 1.135, 95% CI= 1.011, 1.274, p-value=0.032), COVID-19 severity (AHR= 0.660, 95% CI= 0.501, 0.869, p-value=0.003), and cough (AHR= 0.705, 95% CI= 0.519, 0.959, p-value=0.026) were found to be significant determinants of time to clinical improvement. On the binary logistic regression, the following factors were found to be significantly associated with disease outcome; SPO2 (AOR= 0.302, 95% CI= 0.193, 0.474, p-value=0.0001), shortness of breath (AOR= 0.354, 95% CI= 0.213, 0.590, p-value=0.0001) and diabetes mellitus (AOR= 0.549, 95% CI= 0.337, 0.894, p-value=0.016).ConclusionsThe average duration of time to clinical improvement was 14 days and 89.4 % of the patients achieved clinical improvement. The mortality rate of the studied population is lower than reports from other countries including those in Africa. Having severe COVID-19 disease severity and presenting with cough were found to be associated with delayed clinical improvement of the disease. On the other hand, being hyperthermic is associated with shorter disease duration (faster time to clinical improvement). In addition, lower oxygen saturation and subjective complaint of shortness of breath and being diabetic were associated with unfavorable disease outcome. Therefore, patients with these factors should be followed cautiously for a better outcome.

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Section: Discussionmentioning

confidence: 95%

Characteristics and outcome profile of Hospitalized African COVID-19 patients: The Ethiopian Context

Leulseged

et al. 2020

Preprint

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“…Symptoms of fever and fatigue were found to be significant predictors of disease severity showing a 1.252 and 1.414 times increased risk of having severe disease as compared to patients with no such symptoms, respectively. Having symptomatic disease, other than symptoms used in disease classification, in general is reported to delay disease recovery and also found to be associated with more severe disease category in another study conducted at the same Center (MCCC) [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Laboratory biomarkers of COVID-19 disease severity and outcome: Findings from a developing country

et al. 2021

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Aim To identify laboratory biomarkers that predict disease severity and outcome among COVID-19 patients admitted to the Millennium COVID-19 Care Center in Ethiopia. Methods A retrospective cohort study was conducted among 429 COVID-19 patients who were on follow up from July to October 2020. Data was described using frequency tables. Robust Poisson regression model was used to identify predictors of COVID-19 severity where adjusted relative risk (ARR), P-value and 95 CI for ARR were used to test significance. Binary Logistic regression model was used to assess the presence of statistically significant association between the explanatory variables and COVID-19 outcome where adjusted odds ratio (AOR), P-value and 95%CI for AOR were used for testing significance. Results Among the 429 patients studied, 182 (42.4%) had Severe disease at admission and the rest 247 (57.6%) had Non-severe disease. Regarding disease outcome, 45 (10.5%) died and 384 (89.5%) were discharged alive. Age group (ARR = 1.779, 95%CI = 1.405–2.252, p-value <0.0001), Neutrophil to Lymphocyte ratio (NLR) (ARR = 4.769, 95%CI = 2.419–9.402 p-value <0.0001), Serum glutamic oxaloacetic transaminase (SGOT) (ARR = 1.358, 95%CI = 1.109–1.662 p-value = 0.003), Sodium (ARR = 1.321, 95%CI = 1.091–1.600 p-value = 0.004) and Potassium (ARR = 1.269, 95%CI = 1.059–1.521 p-value = 0.010) were found to be significant predictors of COVID-19 severity. The following factors were significantly associated with COVID-19 outcome; age group (AOR = 2.767, 95%CI = 1.099–6.067, p-value = 0.031), white blood cell count (WBC) (AOR = 4.253, 95%CI = 1.918–9.429, p-value = 0.0001) and sodium level (AOR = 3.435, 95%CI = 1.439–8.198, p-value = 0.005). Conclusions Assessing and monitoring the laboratory markers of WBC, NLR, SGOT, sodium and potassium levels at the earliest stage of the disease could have a considerable role in halting disease progression and death.

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“…On the other hand, CDC estimated people with mild to moderate spectrum of symptom and maintain home isolation have a resolution of 3 days after the fever decreased, and there was substantial improvement in respiratory symptoms, even without use of medication. A study conducted in treatment center found in Ethiopia showed that, the rate of prognosis from COVID-19 for asymptomatic cases was higher when compared to symptomatic COVID-19 cases, and this study reported the average recovery time of 16 days [ 8 ]. Another study conducted in Kotebe treatment center of Ethiopia revealed the media time to recovery from COVID-19 was 19 days and it ranges from 2–71 days [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…A comprehensive literature review showed that age greater than 65 years, being hypertensive (up to 40% of patients), diabetics, obesity, cardiovascular and lung disease are possible risk factors for delayed recovery from COVID-19 [ 10 ]. In addition, presence of clinical manifestation on admission also associated with delayed recovery from COVID-19 [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Time to recovery from COVID-19 and its predictors among patients admitted to treatment center of Wollega University Referral Hospital (WURH), Western Ethiopia: Survival analysis of retrospective cohort study

et al. 2021

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Introduction Despite its alarming spread throughout the world, no effective drug and vaccine is discovered for COVID-19 so far. According to WHO, the recovery time from COVID-19 was estimated to be 2 weeks for patients with mild infection, and 3 to 6 weeks for those with serious illnesses. A studies regarding the median recovery time and its predictors are limited globally and specifically in Ethiopia. Therefore, the aim of this study was to estimate the median time to recovery from COVID-19 and its predictors among COVID-19 cases admitted to WURH, Western Ethiopian. Methods This was a hospital-based retrospective cohort study conducted among 263 adult patients admitted with COVID-19 in WURH treatment center from March 29, 2020 through September 30, 2020. Epidata version 3.2 was used for data entry, and STATA version 14 for analysis. A Cox proportional hazard regression model was fitted to determine factors associated with recovery time. A variable with P-value ≤ 0.25 at bivariable Cox regression analysis were selected for multivariable Cox proportional model. Multivariable Cox regression model with 95% CI and Adjusted Hazard Ratio (AHR) was used to identify a significant predictor of time to recovery from COVID-19 at P-value < 0.05. Results The mean age of patient was 36.8 (SD± 10.68) years. At the end of follow up, two hundred twenty seven observations were developed an event (recovered) with median time to recovery of 18 days with IQR of 10–27 days. The overall incidence rate of recovery was of 4.38 per 100 (95% CI: 3.84, 4.99) person-days observations. Being older age (AHR = 1.59, 95% CI: 1.02, 2.49), presence of fever on admission (AHR = 1.78, 95% CI: 1.21, 2.62), and comorbidity (AHR = 0.56, 95% CI, 0.34, 0.90) were found to have statistically significant association with recovery time. Conclusion and recommendations In general, the median recovery time of patients with COVID-19 cases was long, and factors such as older age group, presence of fever, and comorbidity was an independent predictors of delayed recovery from COVID-19. Intervention to further reduce recovery time at treatment center has to focus on patients those shows symptoms and with comorbidities.

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Determinants of Time to Convalescence among COVID-19 Patients at Millennium COVID-19 Care Center in Ethiopia: A prospective cohort study

Cited by 12 publications

References 29 publications

Characteristics and outcome profile of Hospitalized African COVID-19 patients: The Ethiopian Context

Characteristics and outcome profile of Hospitalized African COVID-19 patients: The Ethiopian Context

Laboratory biomarkers of COVID-19 disease severity and outcome: Findings from a developing country

Time to recovery from COVID-19 and its predictors among patients admitted to treatment center of Wollega University Referral Hospital (WURH), Western Ethiopia: Survival analysis of retrospective cohort study

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