Abstract
BackgroundDespite it being a global pandemic, there is little research examining the clinical features of severe COVID-19 in sub-Saharan Africa. This study aims to identify predictors of mortality in COVID-19 patients at Kinshasa Medical Center (KMC).MethodsIn this retrospective, observational, cohort study carried out at the Kinshasa Medical Center (KMC) between March 10, 2020 and July 10, 2020, we included all adult inpatients (≥ 18 years old) with a positive COVID-19 PCR result. The end point of the study was survival. The study population was dichotomized into survivors and non-survivors group. Kaplan–Meier plot was used for survival analyses. The Log-Rank test was employed to compare the survival curves. Predictors of mortality were identified by Cox regression models. The significance level of p value was set at 0.05.Results432 patients with confirmed COVID-19 were identified and only 106 (24.5%) patients with moderate, severe or critical illness (mean age 55.6 ± 13.2 years old, 80.2% were male) were included in this study, of whom 34 (32%) died during their hospitalisation. The main complications of the patients included ARDS in 59/66 (89.4%) patients, coagulopathy in 35/93 (37.6%) patients, acute cardiac injury in 24/98 (24.5%) patients, AKI in 15/74 (20.3%) patients and secondary infection in 12/81 (14.8%) patients. The independent predictors of mortality were found to be age [aHR 1.38; 95% CI 1.10–1.82], AKI stage 3 [aHR 2.51; 95% CI 1.33–6.80], proteinuria [aHR 2.60; 95% CI 1.40–6.42], respiratory rate [aHR 1.42; 95% CI 1.09–1.92] and procalcitonin [aHR 1.08; 95% CI 1.03–1.14]. The median survival time of the entire group was 12 days. The cumulative survival rate of COVID-19 patients was 86.9%, 65.0% and 19.9% respectively at 5, 10 and 20 days. Levels of creatinine (p = 0.012), were clearly elevated in non-survivors compared with survivors throughout the clinical course and increased deterioration.ConclusionMortality rate of COVID-19 patients is high, particularly in intubated patients and is associated with age, respiratory rate, proteinuria, procalcitonin and acute kidney injury.
Highlights
Despite it being a global pandemic, there is little research examining the clinical features of severe COVID-19 in sub-Saharan Africa
The objective of this study was to identify the factors/determinants for COVID-19 related mortality by comparing the demographic and clinical characteristics of patients diagnosed with COVID-19 admitted to the Kinshasa Medical Center (KMC), located in Kinshasa, the capital of the Democratic Republic of Congo (DRC)
Of 432 consecutive patients with COVID-19 who were admitted to the Hospital Emergency Department at KMC between March 10, 2020 and July 10, 2020, only 106 were hospitalized and followed during the study period (Fig. 1)
Summary
Despite it being a global pandemic, there is little research examining the clinical features of severe COVID-19 in sub-Saharan Africa. The clinical manifestations of this new disease vary widely in severity; ranging from no or mild symptoms to patients with pneumonia progressing rapidly to acute respiratory distress syndrome (ARDS), multi-organ failure and death [3]. From the onset of the pandemic, WHO predicted high morbidity and mortality rates in African countries. This has not transpired, with Africa reporting much lower rates than most of the rest of the world [4,5,6]. Notwithstanding the huge amount of global research investigating these morbidity and mortality disparities, most of these data emanate from non-African countries
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