Mortality predictors of hospitalized patients with COVID-19: Retrospective cohort study from Nur-Sultan, Kazakhstan

Abstract

Background First reported case of Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) in Kazakhstan was identified in March 2020. Many specialized tertiary hospitals in Kazakhstan including National Research Cardiac Surgery Center (NRCSC) were re-organized to accept coronavirus disease 2019 (COVID-19) infected patients during summer months of 2020. Although many studies from worldwide reported their experience in treating patients with COVID-19, there are limited data available from the Central Asia countries. The aim of this study is to identify predictors of mortality associated with COVID-19 in NRCSC tertiary hospital in Nur-Sultan, Kazakhstan. Methods This is a retrospective cohort study of patients admitted to the NRCSC between June 1st–August 31st 2020 with COVID-19. Demographic, clinical and laboratory data were collected from electronic records. In-hospital mortality was assessed as an outcome. Patients were followed-up until in-hospital death or discharge from the hospital. Descriptive statistics and factors associated with mortality were assessed using univariate and multivariate logistic regression models. Results Two hundred thirty—nine admissions were recorded during the follow-up period. Mean age was 57 years and 61% were males. Median duration of stay at the hospital was 8 days and 34 (14%) patients died during the hospitalization. Non-survivors were more likely to be admitted later from the disease onset, with higher fever, lower oxygen saturation and increased respiratory rate compared to survivors. Leukocytosis, lymphopenia, anemia, elevated liver and kidney function tests, hypoproteinemia, elevated inflammatory markers (C-reactive protein (CRP), ferritin, and lactate dehydrogenase (LDH)) and coagulation tests (fibrinogen, D-dimer, international normalized ratio (INR), and activated partial thromboplastin time (aPTT)) at admission were associated with mortality. Age (OR 1.2, CI:1.01–1.43), respiratory rate (OR 1.38, CI: 1.07–1.77), and CRP (OR 1.39, CI: 1.04–1.87) were determined to be independent predictors of mortality. Conclusion This study describes 14% mortality rate from COVID-19 in the tertiary hospital. Many abnormal clinical and laboratory variables at admission were associated with poor outcome. Age, respiratory rate and CRP were found to be independent predictors of mortality. Our finding would help healthcare providers to predict the risk factors associated with high risk of mortality. Further investigations involving large cohorts should be provided to support our findings.

Predictors of hospital length of stay and mortality among COVID‐19 inpatients during 2020–2021 in Hormozgan Province of Iran: A retrospective cohort study

“…These findings are supported by other research studies 20,36,37 . In contrast, Yuriy Pya 31 reported no association between comorbidities and mortality in their study. However, they suggested that this may have been due to certain comorbidities going undiagnosed or incomplete data, indicating a need for further research in this area.…”

Comparative Study of Vaccinated and Unvaccinated Hospitalised Patients: A Retrospective Population Study of 500 Hospitalised Patients with SARS-CoV-2 Infection in a Spanish Population of 220,000 Inhabitants

“…In this regard, both serum iron and transferrin are found to be inversely correlated with proinflammatory cytokines such as interleukin-6; thus, low serum iron and transferrin levels are associated with a poor prognosis in SARS-CoV-2 infection cases [ 15 ]. Moreover, elevated serum ferritin levels have also been linked to an increased risk of severe COVID-19 [ 16 ], ICU admission, and mortality rate [ 17 , 18 ].…”

Factors associated with adverse outcomes among patients hospitalized at a COVID-19 treatment center run by Médecins sans Frontières in Herat, Afghanistan

“…Identified factors have included: higher age, male gender, low oxygen saturation at admission, tachypnea and various laboratory determinants such as lymphopenia, low hemoglobin levels, elevated c-reactive protein (CRP), lactate dehydrogenase (LDH) and urea, hyponatremia, hyperkalemia and abnormal coagulation parameters. 11,[18][19][20][21][22][23][24][25]…”

“…[5][6][7][8][9] After admission to hospital, published mortality rates range widely between 2% and 60%, depending on various factors such as the type of care facility (e.g., equipped for critical care or not), hospital equipment and number and qualification of staff. [10][11][12][13][14][15] Multiple meta-analyses have estimated the in-hospital mortality to be around 17% (95% CIs ranging from 12.7% to 22.7%) 16,17 Many studies have researched predictors for in-hospital mortality. Identified factors have included: higher age, male gender, low oxygen saturation at admission, tachypnea and various laboratory determinants such as lymphopenia, low hemoglobin levels, elevated c-reactive protein (CRP), lactate dehydrogenase (LDH) and urea, hyponatremia, hyperkalemia and abnormal coagulation parameters.…”