Predictors of Mortality among Hospitalized Patients with COVID-19 in Egypt-A Retrospective Observational Study

The prediction of mortality and risk stratification of severe coronavirus disease 2019 (Covid-19) offers a rational approach for clinical support, health resource allocation, and implementation of protective interventions to optimize the treatment. Clinicians need these predictors that permit them to elderly patients with Covid-19 rapidly during the pandemic. Investigate demographic features, clinical characteristics, laboratory parameters, and pharmacological treatment received by individuals who died due to Covid-19 that may be predictors of mortality. A retrospective observational study. A single-center cohort in Almaza Fever Egyptian Hospital through three years of the pandemic, 2020, 2021, and 2022. About 194 elderly patients with Covid-19 were attendees of the hospital and died through three years of the pandemic, 2020, 2021, and 2022. A total of 64 cases were in 2020, 94 cases in 2021, and 36 cases in 2022. Main outcome measures: Mortality after a short stay of 9 days evaluated by the area under the curve (AUC), determination of the clinical features, and laboratory measures that may be predictors related to mortality over the three years of the pandemic. Our research found a statistically significant variation between the three years (2020, 2021, and 2022) regarding co-morbidities including IHD, renal and stroke (p-value < 0.05), treatment including Iverzine, chloroquine, remedisvir, and SL (P-value < 0.001), and symptoms including pneumonia status, cytokine storm, dyspnea, cough, anosmia, loss of taste and GIT symptoms (p-value < 0.005). After analysis, there were some predictors, including male sex, age, and hospital stay, that were positively associated with the deterioration of some laboratory measures and biomarkers such as IL-6 with mortality after a short period of stay (9 days) over time. The presented study showed a reliable prediction of mortality over time, so, it plays a crucial role in early patients' identification who are at high risk of death. Therefore, the deteriorated cases should be closely monitored.

INTRODUCTION

The coronavirus disease 2019 (Covid-19) illness, utilizing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogenesis, leads to excellent health and societal burdens globally¹¹. The early symptoms noted in Covid-19 patients range from mild to severe²². Mild symptoms include cough, sore throat, fever, dyspnea, anorexia, and fatigue³³. A previous study in 552 Chinese hospitals and 30 regions involving 1099 affirmed Covid-19 occurrences. It detected a high percentage of cough (67.7%) and fever (87.9%), and a low percentage of vomiting and diarrhea (less than 5%) occurrence⁴⁴. The virus may cause severe problems in some patients, such as pneumonia, sepsis, acute respiratory distress syndrome (ARDS), hyperinflammation, neurological symptoms, or multisystem organ failure⁵⁵.

Our community was significantly impacted by the early Covid-19 pandemic, which seriously affected our everyday routines, financial prudence, and healthcare structures. The adoption of public healthcare programs lowered the rate of infection; however, there is a significant risk that relaxing these regulations will result in the next global epidemic flood, which is already being seen in many nations. The fatality rate of most serious SARS-CoV-2 illnesses transferred to the intensive care (ICU) differs between study results, varying in hospital setting SARS-CoV-2 pneumonia patients (8.1% - 30%) and in intensive care patients (16% - 78%)⁶⁶. Furthermore, 283 million recorded incidents and 5.41 million reported deaths from Covid-19 on 25 December 2021 in over 237 nations, with a worldwide fatality rate of 1.9% and a sharp everyday rise in the number of occasions⁷⁷.

Moreover, in the initial Wuhan study, from 41 patients with Covid-19 pneumonia, six (14.6%) patients quickly deteriorated and died due to multiple organ failure;³when the study sample size increased to 99 cases, the deaths were 11 (11.1%)⁸⁸. In another Wuhan study, 4.3% (six out of 138) was the total mortality in hospitalized Covid-19 pneumonia patients⁹⁹. Additionally, hospitalization rates, from the first wave in the spring of 2020 until the end of April, increased from 20% to 70%¹⁰¹⁰.

As of March 2020, numerous investigations on the clinical features of patients with Covid-19 have been publicly released in both minor (n=58¹¹¹¹, n=2006) and major studies (n>50007¹²¹²). However, such research findings found significant differences in patient features that were linked to poor outcomes. Interestingly, these research findings provide only data about clinical findings and predictors on a group level but not about individual patients' prognoses. Furthermore, Covid-19 mortality predictors were defined in multiple types of research involving advanced age¹³¹³, male sex¹⁴¹⁴, and comorbidities¹⁵¹⁵including coronary artery disease, diabetes mellitus, obesity, malignancy, renal diseases, and hypertension.¹⁶¹⁶Also, some symptoms included fever¹⁷¹⁷, cough¹⁷¹⁷, hemoptysis¹³¹³, dyspnea¹³¹³, fatigue¹⁷¹⁷, and loss of consciousness¹³¹³, and laboratory measures included high neutrophil-to-lymphocyte ratio (NLR)¹³¹³, and high creatinine level¹⁵¹⁵, lactate dehydrogenase (LDH)¹³¹³, direct bilirubin¹³¹³and alanine aminotransferase¹⁵¹⁵, which indicated disease severity, high biomarkers level like serum ferritin, D-dimer¹⁵, interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP)¹⁴and reinforces these outcomes¹⁵¹⁵.

Estimation of fatalities and risk stratification provides a logical strategy for clinical support, health care services allotment, and constructing protective methods to maximize treatments available. The effectiveness of special antiviral and directed immunomodulatory treatment is still enigmatic. Additionally, clinical professionals should have a critical need for mortality-leading indicators that enable rapid management of severe (Covid-19) illness¹⁸¹⁸.

Despite extensive research currently reporting death rates and risk factors worldwide, in-depth research on the clinical traits and consequences of Covid-19 patients in Egypt is still lacking. Therefore, completing the knowledge gap by comprehending the clinical characteristics of Covid-19 can aid in mapping the illness, identifying patients at high risk, and directing healthcare administration in the future. The main goal of this retrospective non-interventional study was to better map and manage the Covid-19 pandemic by examining the clinical characteristics of the virus and locating potential predictors associated with mortality.

MATERIALS AND METHODS

Design and Population is A retrospective observational study was performed to collect data from the medical records of every individual who died from Covid-19 and was an attendee of Almaza Fever Hospital, through three years of pandemic. The study started on January 2023, and the data were collected retrospectively from records starting from 1/1/2020 till the end of 2022.

Inclusion and Exclusion Criteria only patients who died and had complete laboratory results in their records were included in the study. Patients who didn’t have complete records with laboratory results were excluded.

Data collection our research examined retrospective data collected from medical files in Almaza Fever Hospital to assess the clinical consequences of 194 hospitalized elderly patients who died from Covid-19 through three years of the pandemic, 2020, 2021, and 2022. The positive polymerase chain reaction (PCR) was the confirmation test for the diagnosis of Covid-19 illness according to the SARS-CoV-2 virus testing.

Data of some variables were detected, including; sex, age, comorbidities, length of stay in the hospital, pneumonia and other symptoms, laboratory results (neutrophils, d-dimers, hemoglobin, C-reactive protein (CRP), urea, alanine aminotransferase (ALT), aspartate aminotransferase (AST), platelets (PLT), TLC, creatinine, ferritin, and IL-6)