Predictors of Severity in Covid-19 Patients in Casablanca, Morocco

Abstract

Background Morocco was affected, as were other countries, by the coronavirus disease 2019 (COVID-19) pandemic. Many risk factors of COVID-19 severity have been described, but data on infected patients in North Africa are limited. We aimed to explore the predictive factors of disease severity in COVID-19 patients in a tertiary hospital in Casablanca. Methods In this single-center, retrospective, observational study, we included all adult patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, admitted to Sheikh Khalifa International University Hospital in Casablanca between March 18 and May 20, 2020. Patients were separated into two groups: Non-severe patients were those with mild or moderate forms of COVID-19, and severe patients were those admitted to the intensive care unit (ICU) who had one of the following signs-respiratory rate > 30 breaths/min; oxygen saturation < 93% on room air; acute respiratory distress syndrome (ARDS); or required mechanical ventilation. Demographic, clinical, laboratory data, and outcomes were reviewed. We used univariable and multivariable logistic regression to explore predictive factors of severity. Results We reported 134 patients with confirmed SARS-CoV-2 infection. The median age was 53 years (interquartile range [IQR], 36-64), and 73 (54.5%) were men. Eighty-nine non-severe patients (66.4%) were admitted to single bedrooms, and 45 (33.6%) were placed in the ICU. The median time from illness onset to hospital admission was seven days (IQR, 3.0-7.2). Ninety-nine patients (74%) were admitted directly to the hospital, and 35 (26%) were transferred from other structures. Also, 68 patients (65.4%) were infected in clusters. Of the 134 patients, 61 (45.5%) had comorbidities, such as hypertension (n = 36; 26.9%), diabetes (n = 19; 14.2%), and coronary heart disease (n = 16; 11.9%). The most frequent symptoms were fever (n = 61; 45.5%), dry cough (n = 59; 44%), and dyspnea (n = 39; 29%). A total of 127 patients received hydroxychloroquine and azithromycin (95%). Eleven critical cases received lopinavir/ritonavir (8.2%). Five patients received tocilizumab (3.7%). We reported 13 ARDS cases in ICU patients (29%), eight with acute kidney injury (17.8%), and four thromboembolic events (8.8%). Fourteen ICU patients (31.1%) died at 28 days. In univariable analysis, older men with one or more comorbidities, infection in a cluster, chest scan with the COVID-19 Reporting and Data System (CO-RADS) 5, lymphopenia, high rates of ferritin, C-reactive protein (CRP), D-dimer, and lactate dehydrogenase were associated with severe forms of COVID-19. Multivariable logistic regression model founded increasing odds of severity associated with older age (odds ratio [OR] 1.05, 95% confidence interval [

Different incidences of acute kidney injury (AKI) and outcomes in COVID‐19 patients with and without non‐azithromycin antibiotics: A retrospective study

“…An observational study conducted in Morocco to determine the predictors of severity in COVID-19 revealed that azithromycin was the most common prescribed antibiotic in both patients in ICU and non-ICU, and third-generation cephalosporin, quinolones, aminoglycosides, and carbapenem were significantly more administered in ICUs (p < 0.001). 49 The study by Liu et al 50 on 1123 patients with COVID-19 showed that antibiotics were associated with increased in-hospital deaths (OR = 5.58; 95% CI: 53 Therefore, the appropriate dosage of antibiotics should be administered for patients with COVID-19 and be monitored continuously to prevent from AKI.…”

Personal Protective Equipment and Headaches: Cross-Sectional Study Among Moroccan Healthcare Workers During COVID-19 Pandemic

“…This is a cross-sectional study conducted at Cheikh Khalifa International University Hospital (CKIUH), a tertiary care university hospital situated in the Casablanca-Settat region, the largest one in the kingdom of Morocco with a population of 6,862,000 inhabitants and the most hit by COVID-19 pandemic in Morocco [ 16 , 17 ].…”

“…Severe COVID-19 cases were managed at a dedicated critical care and intensive care units with a capacity of 23 beds. Additionally, a fully functional field hospital has been rapidly set up to receive more patients for isolation and follow-up [ 17 ].…”

COVID-19 and the Kidney: A Worrisome Scenario of Acute and Chronic Consequences

“…Furthermore, of the patients with AKI, 8.6% required kidney replacement therapy (KRT). Differently, a cohort from Casablanca, Morocco showed a lower incidence of AKI within patients requiring ICU stay, reporting an AKI incidence of 17.8% [ 32 ]. Preliminary, non-published data from the Latin American Society of Nephrology and Hypertension (SLANH) report that 50.3% of 393 hospitalized patients with CoV-AKI required KRT, the highest reported until now [ 33 ].…”