Abstract
We aimed to assess the epidemiological, clinical, and laboratory characteristics associated with mortality among hospitalized Egyptian patients with COVID-19. A multicenter, retrospective study was conducted on all polymerase chain reaction (PCR)-confirmed COVID-19 cases admitted through the period from April to July 2020. A generalized linear model was reconstructed with covariates based on predictor’s statistical significance and clinically relevance. The odds ratio (OR) was calculated by using stepwise logistic regression modeling. A total of 3712 hospitalized patients were included; of them, 900 deaths were recorded (24.2%). Compared to survived patients, non-survived patients were more likely to be older than 60 years (65.7%), males (53.6%) diabetic (37.6%), hypertensive (37.2%), and had chronic renal insufficiency (9%). Non-survived patients were less likely to receive azithromycin (p <0.001), anticoagulants (p <0.001), and steroids (p <0.001). We found that age ≥ 60 years old (OR = 2.82, 95% CI 2.05–3.86; p <0.0001), diabetes mellitus (OR = 1.58, 95% CI 1.14–2.19; p = 0.006), hypertension (OR = 1.69, 95% CI 1.22–2.36; p = 0.002), chronic renal insufficiency (OR = 3.15, 95% CI 1.84–5.38; p <0.0001), tachycardia (OR = 1.65, 95% CI 1.22–2.23; p <0.001), hypoxemia (OR = 5.69, 95% CI 4.05–7.98; p <0.0001), GCS <13 (OR 515.2, 95% CI 148.5–1786.9; p <0.0001), the use of therapeutic dose of anticoagulation (OR = 0.4, 95% CI 0.22–0.74, p = 0.003) and azithromycin (OR = 0.16, 95% CI 0.09–0.26; p <0.0001) were independent negative predictors of mortality. In conclusion, age >60 years, comorbidities, tachycardia, hypoxemia, and altered consciousness level are independent predictors of mortality among Egyptian hospitalized patients with COVID-19. On the other hand, the use of anticoagulants and azithromycin is associated with reduced mortality.
Highlights
The clinical features and outcomes of Coronavirus disease-2019 (COVID-19) vary substantially from asymptomatic/mild flu-like manifestations, which resolve entirely by the end of the disease to severe forms in a subset of patients, including severe pneumonia, acute respiratory distress syndrome, sepsis, thromboembolic manifestations, acute myopericarditis, septic shock, multi-organ failure, and eventually death [1,2,3,4]
We found that age 60 years old (OR = 2.82, 95% CI 2.05–3.86; p
We found that age >60 years (OR = 2.84, 95% CI (2.41–3.36, p
Summary
The clinical features and outcomes of Coronavirus disease-2019 (COVID-19) vary substantially from asymptomatic/mild flu-like manifestations, which resolve entirely by the end of the disease to severe forms in a subset of patients, including severe pneumonia, acute respiratory distress syndrome, sepsis, thromboembolic manifestations, acute myopericarditis, septic shock, multi-organ failure, and eventually death [1,2,3,4]. While the adequacy of healthcare services may play a role in such inconsistencies, multicenter reports highlighted that patient-specific factors are significant determinants of the presentation and outcomes of COVID-19. The Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) enters the host cell by endocytosis after binding of its spike (S) protein to angiotensin-converting enzyme -2 (ACE2) receptors in concert with S-protein priming by the host cell transmembrane serine protease TMPRSS. This leads to dysregulation of the angiotensin system and release of Tumor necrosis factor (TNF)-α along with interleukin (IL)-6 and other cytokine mediators, predisposing to the cytokine storm in severe COVID-19 [11]. Immune system remodeling, or immunosenescence that occurs in elderly patients, is considered the principal underlying factor for increased susceptibility to infection, respiratory infections such as influenza and impaired immune responses to vaccination [11]
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