Mortality Risk Factors in Severe and Critical COVID-19 Patients at Antsiranana University Hospital

Abstract

Backgrounds: This study focuses on identifying risk factors associated with mortality in patients with severe or critical COVID- 19 at the University Hospital of Antsiranana, Madagascar. Since the pandemic’s onset, African healthcare systems have faced significant challenges due to limited intensive care resources, contributing to higher mortality rates. Madagascar has reported a COVID-19 case fatality rate of around 2%. The aim of this study is to identify mortal- ity risk factors to improve patient management and reduce death rates in severely ill patients. Methods: This retrospective cohort study was conducted from March 2020 to March 2022, including hospitalized patients with confirmed or probable COVID-19 infection. Data on demographics, clinical symptoms, laboratory tests, and treatments were collected. Univariate and multivariate analyses were performed to identify risk factors associated with mortality. Results: Out of 124 patients, 25 (20.2%) died. The median age was 58.6 years, with 48.4% over the age of 60. The most common symptoms were cough (73.4%), dyspnea (70.2%), and fever (68.5%). Comorbidities were present in 65.32% of the patients, with hypertension (50%) and diabetes (29.8%) being the most frequent. Multivariate anal- ysis revealed that cardiac and respiratory deterioration, as well as shock, were strongly associated with increased mortality risk Conclusion: The findings confirm that comorbidities, particularly hypertension and diabetes, are significant risk factors for COVID-19 mortality. Respiratory decline, cardiac decompensation, and altered consciousness at admis- sion were also critical prognostic indicators. Hospital mortality rates were consistent with other studies in similar low-resource settings, though the actual rates may be underreported due to limited healthcare resources. This study highlights the importance of early management of comorbidities and respiratory and cardiac complications in severe COVID-19 patients to reduce mortality.