Predictive Factors of Death and the Clinical Profile of Hospitalized Covid-19 Patients in Morocco: A One-Year Mixed Cohort Study

Abstract

BackgroundSince the onset of the Covid-19 pandemic, several studies have been conducted around the world in an attempt to understand this heterogeneous and unpredictable disease and to prevent related death. It was therefore necessary to study the associated risk factors of Covid-19-related mortality. ObjectivesThe aim of this study was to describe the clinical profile and to identify the factors associated with mortality of patients with Covid-19 in Morocco. MethodsWe performed a mixed cohort study (retrospective and prospective) of 615 in-patients with Covid-19 disease, enrolled between August 2020 and October 2021. We followed the cohort throughout the hospitalization until discharge and 30 days thereafter. ResultsThe median age was 64 years old; 62.1% of the patients were male. The mean time from symptom onset to hospitalization was 8.5 days (±4.67), and 68.1% of patients had comorbidities. On admission, the most common symptoms were dyspnea (82.2%), cough (80.3%), and fever (76.8%). The main follow-up complication was secondary infection (56.9%). Based on univariate analysis, male gender (p<0.008 and brut relative risk { b RR}=1.57), advanced age (p<0.001), lung involvement (p<0.001), lymphopenia (p<0.001 and b RR=2.32), D-dimers of >500 µg/l (p<0.007 and b RR=2.47), C-reactive protein (CRP) of >130 mg/l (p<0.001 and b RR=2.45), elevated creatinine (p<0.013 and b RR=1.61), lactate dehydrogenase (LDH) of >500 U/l (p<0.001 and b RR=7.16), receiving corticosteroids (p<0.001 and b RR=5.08), invasive ventilation (p<0.001 and b RR=30.10), the stay in the resuscitation unit (p<0.001 and b RR=13.37), and acute respiratory distress syndrome (ARDS) (p<0.001 and b RR=10.98) were associated with a higher risk of death. In the opposite, receiving azithromycin and hydroxychloroquine (p<0.001 and b RR=0.28) and pre-admission anticoagulants (p<0.005 and b RR=0.46) was associated with a lower risk of mortality. Multivariate regression analysis showed that age of >60 years (p<0.001 and adjusted odds ratio {aOR}=4.90), the use of invasive ventilation (p<0.001 and aOR=9.60), the stay in the resuscitation unit (p<0.001 and aOR=5.09), and acute respiratory distress syndrome (p<0.001 and aOR=6.49) were independent predictors of Covid-19 mortality. ConclusionIn this cohort study focusing on Covid-19 in-patient's mortality, we found that age of >60 years, the use of invasive ventilation, the stay in the resuscitation unit, and acute respiratory distress syndrome were independent predictors of Covid-19 mortality. The results of this study can be used to improve knowledge for better clinical management of Covid-19 in-patients.