Predictors of death in severe COVID-19 patients at millennium COVID-19 care center in Ethiopia: a case-control study

Leulseged, Tigist Workneh; Maru, Endalkachew H.; Hassen, Ishmael S.; Zewde, Wuletaw C.; Chamiso, Negat W; Abebe, Daniel S.; Jagema, Tariku B.; Banegyisa, Abdi Bekele; Gezahegn, Mesfin A.; Tefera, Oli S.; Shiferaw, Wondmagegn G.; Admasu, Teketel T.

doi:10.11604/pamj.2021.38.351.28831

Cited by 21 publications

(31 citation statements)

References 17 publications

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“…This implies that non-respiratory symptoms also might have a predictive value in disease categorization. This is also demonstrated by other studies in Ethiopia [ 4 , 5 , 24 – 26 ].…”

Section: Discussionsupporting

confidence: 86%

“…Having a history of pre-existing co-morbid illness particularly hypertension, diabetes, severe asthma, cancer, renal disease, cardiovascular, cerebrovascular diseases, and other co-morbidities were also found to be predictors of severe disease [ 6 – 23 ]. This is also reported in studies conducted in Ethiopia [ 4 , 5 , 24 – 26 ].…”

Section: Introductionsupporting

confidence: 82%

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COVID-19 disease severity and associated factors among Ethiopian patients: A study of the millennium COVID-19 care center

et al. 2022

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Background The COVID-19 pandemic started a little later in Ethiopia than the rest of the world and most of the initial cases were reported to have a milder disease course and a favorable outcome. This changed as the disease spread into the population and the more vulnerable began to develop severe disease. Understanding the risk factors for severe disease in Ethiopia was needed to provide optimal health care services in a resource limited setting. Objective The study assessed COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia for characteristics associated with COVID-19 disease severity. Methods A cross-sectional study was conducted from June to August 2020 among 686 randomly selected patients. Chi-square test was used to detect the presence of a statistically significant difference in the characteristics of the patients based on disease severity (Mild vs Moderate vs Severe). A multinomial logistic regression model was used to identify factors associated with COVID-19 disease severity where Adjusted Odds ratio (AOR), 95% CIs for AOR and P-values were used for significance testing. Results Having moderate as compared with mild disease was significantly associated with having hypertension (AOR = 2.30, 95%CI = 1.27,4.18), diabetes mellitus (AOR = 2.61, 95%CI = 1.31,5.19for diabetes mellitus), fever (AOR = 6.12, 95%CI = 2.94,12.72) and headache (AOR = 2.69, 95%CI = 1.39,5.22). Similarly, having severe disease as compared with mild disease was associated with age group (AOR = 4.43, 95%CI = 2.49,7.85 for 40–59 years and AOR = 18.07, 95%CI = 9.29,35.14for ≥ 60 years), sex (AOR = 1.84, 95%CI = 1.12,3.03), hypertension (AOR = 1.97, 95%CI = 1.08,3.59), diabetes mellitus (AOR = 3.93, 95%CI = 1.96,7.85), fever (AOR = 13.22, 95%CI = 6.11, 28.60) and headache (AOR = 4.82, 95%CI = 2.32, 9.98). In addition, risk factors of severe disease as compared with moderate disease were found to be significantly associated with age group (AOR = 4.87, 95%CI = 2.85, 8.32 for 40–59 years and AOR = 18.91, 95%CI = 9.84,36.331 for ≥ 60 years), fever (AOR = 2.16, 95%CI = 1.29,3.63) and headache (AOR = 1.79, 95%CI = 1.03, 3.11). Conclusions Significant factors associated with severe COVID-19 in Ethiopia are being older than 60 years old, male, a diagnosis of hypertension, diabetes mellitus, and the presence of fever and headache. This is consistent with severity indicators identified by WHO and suggests the initial finding of milder disease in Ethiopia may have been because the first people to get COVID-19 in the country were the relatively younger with fewer health problems.

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“…This implies that non-respiratory symptoms also might have a predictive value in disease categorization. This is also demonstrated by other studies in Ethiopia [ 4 , 5 , 24 – 26 ].…”

Section: Discussionsupporting

confidence: 86%

Section: Introductionsupporting

confidence: 82%

COVID-19 disease severity and associated factors among Ethiopian patients: A study of the millennium COVID-19 care center

et al. 2022

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“…The effect of concomitant comorbid illness on disease progression is also reported to be the same in other studies [2,[31][32][33][34]. Patients with diabetes mellitus were also found to increased likelihood of having death outcome, developing symptomatic disease and more severe disease category in studies conducted in our center [27,28,35].…”

Section: Plos Onesupporting

confidence: 82%

“…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 Patients with COVID-19 in other studies conducted in our Center [ 3 , 4 , 28 , 30 ]. Having diabetes mellitus was associated with a 45.1% lower odds of achieving clinical recovery compared to those with no such comorbid illness.…”

Section: Discussionmentioning

confidence: 54%

“…On the other hand, another study in the Center shows that having fever is associated with development of a more severe disease. This could be because having fever is an implication of competent body defense system that can lead to better outcome from the disease even though it could be associated with development of a more severe disease category [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and outcome profile of hospitalized African patients with COVID-19: The Ethiopian context

et al. 2021

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Background The COVID-19 pandemic seems to have a different picture in Africa; the first case was identified in the continent after it had 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 pandemic in the African setup is therefore crucial. Aim To assess the characteristics and outcome of Patients with COVID-19 and to identify determinants of the disease outcome among patients admitted to Millennium COVID-19 Care Center in Ethiopia. Methods A prospective cohort study was conducted among 1345 consecutively admitted RT-PCR confirmed Patients with COVID-19 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 recovery 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 results. Results Among 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 recovery 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 recovery. 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). Conclusions The average duration of time to clinical recovery was 14 days and 89.4% of the patients achieved clinical recovery. 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 recovery of the disease. On the other hand, being hyperthermic is associated with shorter disease duration (faster time to clinical recovery). In addition, lower oxygen saturation, 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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Survival status and predictors of mortality among COVID-19 patients admitted to intensive care units at COVID-19 centers in Addis Ababa, Ethiopia: a retrospective study

Boka

Tadesse

W/Yohannes

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction: Worldwide, including in Ethiopia, there is an increased risk of coronavirus disease 2019 (COVID-19) disease severity and mortality. This study aimed to assess the survival status and predictors of mortality among COVID-19 patients admitted to the intensive care unit. Methods: This study included 508 COVID-19 patients retrospectively who were under follow-up. The work has been reported in line with the STROCSS (strengthening the reporting of cohort, cross-sectional and case–control studies in surgery) criteria. The data were collected through a systematic sampling from patients’ charts. Kaplan–Meier survival curves and logrank test, and Cox’s regression analyses were conducted to check the difference among categories of covariates and to identify predictors of mortality, respectively. Results: All patient charts were reviewed and the information was recorded. The average age (mean+SD) of these patients was 62.1+13.6 years. Among study participants, 422 deaths occurred and the mortality rate was 64.1 per 1000 person-days. The median survival time was 13 days [interquartile range (IQR): 10–18]. The significant predictors for this survival were: Age>45 years [adjusted hazard ratio (AHR)=4.34, 95% CI: 2.46–7.86], Diabetes mellitus (AHR=1.37, 95% CI: 1.05–1.77), Hypertension (AHR=1.39, 95% CI: 1.09–1.79), Renal disease (AHR=1.86, 95% CI: 1.01–3.43), Hypotension (AHR=1.71, 95% CI: 1.28–2.27), Electrolyte treatment (AHR=0.78, 95% CI: 0.63–0.97). Conclusion: The median survival of COVID-19 patients after their admission was 13 days, and predictors for this time were advanced age, preexisting comorbidities (like diabetes mellitus, hypertension, and renal disease), hypotension, and electrolyte therapy.

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Predictors of death in severe COVID-19 patients at millennium COVID-19 care center in Ethiopia: a case-control study

Cited by 21 publications

References 17 publications

COVID-19 disease severity and associated factors among Ethiopian patients: A study of the millennium COVID-19 care center

COVID-19 disease severity and associated factors among Ethiopian patients: A study of the millennium COVID-19 care center

Characteristics and outcome profile of hospitalized African patients with COVID-19: The Ethiopian context

Survival status and predictors of mortality among COVID-19 patients admitted to intensive care units at COVID-19 centers in Addis Ababa, Ethiopia: a retrospective study

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