Epidemiological and clinical presentations of hospitalized COVID-19 patients in Libya: An initial report from Africa

Abstract

Background The first case of the novel coronavirus disease 2019 (COVID-19) in Libya was diagnosed in March 2020. We aimed to determine the epidemiological, clinical, and laboratory characteristics of COVID-19 in Libya. Method In this retrospective descriptive study, we analyzed the demographics, initial clinical presentation, history, comorbidities, laboratory findings, complications, and outcomes of hospitalized patients with COVID-19 at several centers in the Western part of Libya between March 24, 2020, and December 3, 2020. Results The study included 811 (67.2%) men and 396 (32.8%) women. The median (interquartile range [IQR]) age was 56 (40–64). A total of 173 (14.3%) patients developed respiratory distress syndrome, while 70 (5.8%) developed circulatory shock and hypotension; 190 (15.7%) were admitted to the intensive care unit. Acute cardiac injury occurred in 27 (2.2%) patients, and 45 (3.7%) developed arrhythmia. Acute kidney injury occurred in 44 (3.6%) patients. Of the patients admitted during the study period, 149 (12.3%) died. The predominant comorbidities ordered in a descending manner were as follows; diabetes mellitus, presented 490 (40.6%), hypertension in 414 (34.3%), chronic kidney disease in 114 (9.4%), and lung diseases in 103 (8.5%). The total white blood cell, neutrophil; monocyte; D-dimer; creatinine kinase; creatine kinase–MB; creatinine; total bilirubin; alanine and aspartate aminotransferase; and hypersensitive troponin were increased among non-survivors, whereas lymphocyte and platelet counts were decreased among non-survivors. Conclusion This is the first report of the clinical presentations and laboratory findings in patients hospitalized with COVID-19 in Libya. Libyan authorities must implement several restrictions to control the pandemic. However, incoming international travelers pose a challenge to the local authorities, especially with the recent discovery of new variants.

Epidemiologic Characteristics of and Prognostic Factors for COVID-19 Among Hospitalized Patients: Updated Implications From Hubei Province, China

“…A higher level of creatinine was associated with a higher probability of death or severe disease. This finding was consistent with a study on 113 patients in China with fatal disease (7), a study on 1,207 patients in Libya (42), and a systematic review of 207 studies from multiple countries (33). Furthermore, to identify and care for patients with increasing creatinine levels, attention should be focused on male patients with creatinine levels >104 µmol/L and female patients with creatinine levels > 90 µmol/L.…”

“…Concerning AST, a study from Libya ( 42 ) reached a similar conclusion as that of our study. The increased level of AST would increase the possibility of death.…”

“…Regarding other laboratory indicators with significance in univariate analyses in our study for which there was supporting evidence from national and international studies, WBC count ( 30 , 33 , 39 , 42 – 45 ), percentage of lymphocytes ( 8 ), PLT count ( 8 , 33 , 42 , 46 – 48 ), CRP level ( 8 , 33 , 43 , 46 , 48 , 49 ), neutrophil count ( 33 , 42 , 43 , 48 ), ALB level ( 33 , 43 , 49 ), blood UN ( 9 , 33 ), and blood glucose level ( 45 ) were also associated with prognosis. However, some significant laboratory parameters, such as lactate dehydrogenase ( 7 , 8 , 33 , 44 , 45 ), D-dimer ( 7 , 8 , 10 , 33 , 43 ), and procalcitonin ( 5 , 33 , 44 , 50 ), were not investigated in our study owing to a lack of data.…”

“…Several previous studies have found that lymphocyte count is one of the most significant factors for COVID-19 prognosis and is a predictor of death ( 38 ). Most results of previous studies conducted in China and other countries found that lymphopenia was associated with a poorer prognosis ( 33 , 35 , 39 – 42 ), and one study found that a lymphocyte count <0.8 ×10 9 cells/L was associated with an increased risk of severe COVID-19 ( 43 ). However, in our study, a lymphocyte count exceeding the upper limit of normal (>3.2 ×10 9 cells/L) was associated with a poorer prognosis.…”

COVID-19-associated AKI

“…incidences in China, the incidences of reported AKI in parts of Africa and Southern India are peculiarly low with most reports stating an incidence between 4 and 7% [28][29][30][31]. In contrast, the AKI incidence rate of 36-50% in South America was comparable with those observed in Europe and Northern America [32,33].…”