Duration of Supplemental Oxygen Requirement and Predictors in Severe COVID-19 Patients in Ethiopia: A Survival Analysis

Leulseged, Tigist Workneh; Hassen, Ishmael S.; Edo, Mesay G.; Abebe, Daniel S.; Maru, Endalkachew H.; Zewde, Wuletaw C.; Chamesew, Nigat W.; Jagema, Tariku B.

doi:10.1101/2020.10.08.20209122

Cited by 15 publications

(19 citation statements)

References 19 publications

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“…This could be because shortness of breath and decreased SPO2 are manifestations of diseased lung with diminished capacity, which can be explained also by the high affinity of the SARS-COV-2 virus to attack the lung. Shortness of breath is also found to be associated with increased odds of death and also prolonged oxygen requirement among severe COVID-19 patients in other studies conducted in our Center 24,26 .…”

Section: Discussionsupporting

confidence: 60%

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: Discussionsupporting

confidence: 60%

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

Leulseged

et al. 2020

Preprint

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“…In an earlier observational study of hospitalised COVID-19 patients in regular hospital ward (i.e., outside of ICU), the average duration on supplemental oxygen was 8 days [19]. In another observational study of severe COVID-19 patients, the median time to getting off supplemental oxygen was 6 days [20]. These data are comparable to what we observed in patients in the SOC groups in our current study, with median time to achieving and maintaining SpO 2 ≥94% on room air of 5 days.…”

Section: Discussionmentioning

confidence: 99%

2-Deoxy-D-Glucose as an Adjunct to Standard of Care in the Medical Management of COVID-19: A Proof-of-Concept & Dose-Ranging Randomised Clinical Trial

Bhatt

Shenoy

Munjal

et al. 2021

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Objective: To evaluate the efficacy and safety of 2-deoxy-D-glucose (2-DG) in the treatment of COVID-19. Participants: 110 adults aged 18 to 65 years with moderate to severe COVID-19. Interventions: 63, 90, and 126 mg/kg/day 2-DG plus standard of care (SOC) versus SOC only. Main Outcome Measures: Times to maintaining SpO2 ≥94% on room air discharge, clinical recovery, vital signs normalisation, improvement by 1 and 2 points on WHO 10-point ordinal scale, negative conversion on RT-PCR, intensive care, and mortality. Results: Patients treated with 90 mg/kg/day 2-DG plus SOC showed better outcomes. Time to maintaining SpO2 ≥94% was significantly shorter in the 2-DG 90 mg compared to SOC (median 2.5 days vs 5 days, Hazard ratio [95% confidence interval]=2.3 [1.14, 4.64], p=0.0201). Times to discharge from isolation ward, to clinical recovery, and to vital signs normalisation were significantly shorter for the 2-DG 90 mg group. All three doses of 2-DG were well tolerated. Thirty-three (30.3%) patients reported 65 adverse events and were mostly (86%) mild. Conclusion: 2-DG 90 mg/kg/day as adjunct to SOC showed clinical benefits over SOC alone in the treatment of moderate to severe COVID-19. The promising trends observed in current phase-II study encourage confirmatory evaluation of the efficacy and safety of 2-DG in a larger phase-III trial.

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“…A strength of this study is the use of a method for calculating oxygen provision to hospitalized patients by summing up documented flow-rates in the medical records. Previously, findings of the proportions of patients receiving oxygen (8,30–35) and the duration of oxygen treatment (32) have been presented, as well as assumptions on required oxygen flow (23). To the best of our knowledge, this study is the first to use all the necessary data to be able to calculate total oxygen provision to patients.…”

Section: Discussionmentioning

confidence: 99%

Oxygen provision to severely ill COVID-19 patients at the peak of the 2020 pandemic in a Swedish district hospital

Hvarfner

Al-Djaber

Ekström

et al. 2021

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Oxygen therapy is a low-cost and life-saving therapy for patients with COVID-19. Yet, it is a limited resource in many hospitals in low income countries and in the 2020 pandemic even hospitals in richer countries reported oxygen shortages. An accurate understanding of oxygen requirements is needed for capacity planning. The World Health Organization (WHO) estimates the average flow-rate of oxygen to severe COVID-19-patients to be 10 l/min. However, there is a lack of empirical hospital-based data about the oxygen provision to patients. This study aimed to estimate the oxygen provision to COVID-19 patients with severe disease in a Swedish district hospital. A retrospective, medical records-based cohort study was conducted in March to May 2020 in a Swedish district hospital. All adult patients with severe COVID-19, those who received oxygen in the ward and had no ICU-admission during their hospital stay, were included. Data were collected on the oxygen flow-rates provided to the patients throughout their stay in hospital, and summary measures of oxygen provision calculated. One-hundred and twenty six patients were included. Their median age was 70 years and 43% were female. On admission, 27% had a peripheral oxygen saturation of <=91% and 54% had a respiratory rate of >=25/min. The mean oxygen flow-rate to patients while receiving oxygen therapy was 3.0 l/min (SD 2.9) and the mean total volume of oxygen provided per patient admission was 16,000 l (SD 23,000). In conclusion, the provision of oxygen to severely ill COVID-19-patients was lower than previously estimated. Further research is required before global estimates are adjusted.

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Duration of Supplemental Oxygen Requirement and Predictors in Severe COVID-19 Patients in Ethiopia: A Survival Analysis

Cited by 15 publications

References 19 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

2-Deoxy-D-Glucose as an Adjunct to Standard of Care in the Medical Management of COVID-19: A Proof-of-Concept & Dose-Ranging Randomised Clinical Trial

Oxygen provision to severely ill COVID-19 patients at the peak of the 2020 pandemic in a Swedish district hospital

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