Demographic and Clinical Features Associated with in-Hospital Mortality in Egyptian COVID-19 Patients: A Retrospective Cohort Study

Noha Asem; Mohamed Hassany; Khaled Taema; Hossam Masoud; Gehan Elassal; Ehab Kamal; Wagdy Abdel Moneim Amin; Akram AbdelBary; Amin Mohamed Abdel-Baki; Samy Zaky; Ahmad Said Abdalmohsen; Hamdy Mohamed Ibrahim; Mohamed Abdel Hakim Elnady; Ahmed Sh. Mohamed; Ehab Attia; Hala Zaid

doi:10.3889/oamjms.2021.7226

Authors

Noha Asem Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Ministry of Health and Population, Cairo, Egypt
Mohamed Hassany Department of Hepatology and Tropical Medicine, National Hepatology and Tropical Medicine Research Institute, Ministry of Health and Population, Cairo, Egypt https://orcid.org/0000-0002-6001-8793
Khaled Taema Department of Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt https://orcid.org/0000-0002-4907-7426
Hossam Masoud Department of Pulmonology, Cairo University, Cairo, Egypt https://orcid.org/0000-0002-1465-2283
Gehan Elassal Department of Pulmonology, Ain Shams University, Cairo, Egypt
Ehab Kamal Department of Research and Training, Medical Research Division, National Research Centre, Giza, Egypt; Minster of Health Assistant for Continuous Medical Education, Head of Fever Hospitals Directorate, Ministry of Health and Population, Cairo, Egypt https://orcid.org/0000-0002-2242-3640
Wagdy Abdel Moneim Amin Department of Chest Diseases, Ministry of Health and Population, Cairo, Egypt
Akram AbdelBary Department of Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, EgyptDepartment of Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt https://orcid.org/0000-0001-8533-6694
Amin Mohamed Abdel-Baki Department of Hepatology, Gastroenterology and Infectious Diseases, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
Samy Zaky Department of Hepatogastroenterology and Infectious Diseases, Alazhar University, Cairo, Egypt
Ahmad Said Abdalmohsen Department of Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
Hamdy Mohamed Ibrahim Intensive Care Unit, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
Mohamed Abdel Hakim Elnady Department of Pulmonology, Cairo University, Cairo, Egypt
Ahmed Sh. Mohamed Department of Chest Diseases and Bronchscopy, Tanta University, Tanta, Egypt
Ehab Attia Minster of Health and Population, Ministry of Health and Population, Cairo, Egypt
Hala Zaid Minster of Health and Population, Ministry of Health and Population, Cairo, Egypt

DOI:

https://doi.org/10.3889/oamjms.2021.7226

Keywords:

COVID-19, SARS-COV-2, In-hospital mortality

Abstract

Aim:

We evaluated in this study the demographic and clinical characteristics of COVID-19 disease in Egyptian population with special consideration for its mortality predictors.

Methods:

8162 participants (mean age 48.7±17.3 years,54.5% males) with RT-PCR positive COVID-19 were included. The electronic medical records were reviewed for demographic, clinical, laboratory, and radiologic features. The primary outcome was the in-hospital mortality rate.

Results:

The in-hospital mortality was 11.2%. There was a statistically significant strong association of in-hospital mortality with age >60 years old (OR:4.7; 95% CI 4.1-5.4;p<0.001), diabetes mellitus (OR:4.6; 95% CI 3.99-5.32;p<0.001), hypertension (OR:3.9; 95% CI 3.4-4.5;p<0.001), coronary artery disease (OR:2.7; 95% CI 2.2-3.2;p<0.001), chronic obstructive pulmonary disease (OR:2.1; 95% CI 1.7-2.5;p<0.001), chronic kidney disease (OR:4.8; 95% CI 3.9-5.9;p<0.001), malignancy (OR:3.7; 95% CI 2.3-5.75;p<0.001), neutrophil-lymphocyte ratio >3.1 (OR:6.4; 95% CI 4.4-9.5;P< 0.001), and ground glass opacities (GGOs) in CT chest (OR:3.5; 95% CI 2.84-4.4;P<0.001), respectively. There was a statistically significant moderate association of in-hospital mortality with male gender (OR:1.6; 95% CI 1.38-1.83;p<0.001) and smoking (OR:1.6; 95% CI 1.3-1.9;p<0.001). GGOs was reported as the most common CT finding (occurred in 73.1% of the study participants).

Conclusion:

This multicenter, retrospective study ascertained the higher in-hospital mortality rate in Egyptian COVID-19 patients with different comorbidities.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

World Health Organization. WHO Director-General’s. Opening Remarks at the Media Briefing on COVID-19-11 March 2020. Geneva: World Health Organization; 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 [Last accessed on 2020 Aug 07].

Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157-60. https://doi.org/10.23750/abm.v91i1.9397 PMid:32191675

Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C, Gulyaeva AA, et al. The species severe acute respiratory syndrome-related coronavirus: Classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536-44. https://doi.org/10.1038/s41564-020-0695-z PMid:32123347 DOI: https://doi.org/10.1038/s41564-020-0695-z

Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA. 2020;323(13):1239-42. https://doi.org/10.1001/jama.2020.2648 PMid:32091533 DOI: https://doi.org/10.1001/jama.2020.2648

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. https://doi.org/10.1001/jama.2020.1585 PMid:32031570 DOI: https://doi.org/10.1001/jama.2020.1585

World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report-26 2020. Geneva: World Health Organization; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200215-sitrep-26-covid-19.pdf?sfvrsn=a4cc6787_2 [Last accessed on 2020 Nov 03].

Hassany M, Abdel-Razek W, Asem N, AbdAllah M, Zaid H. Estimation of COVID-19 burden in Egypt. Lancet Infect Dis. 2020;20(8):896-7. https://doi.org/10.1016/S1473-3099(20)30319-4 PMid:32353346 DOI: https://doi.org/10.1016/S1473-3099(20)30319-4

World Health Organization. WHO R&D Blueprint: Informal Consultation on Prioritization of Candidate Therapeutic Agents for use in Novel Coronavirus 2019 Infection, Geneva, Switzerland, 24 January 2020. Geneva: World Health Organization; 2020.

Fantini J, Di Scala C, Chahinian H, Yahi N. Structural and molecular modelling studies reveal a new mechanism of action of chloroquine and hydroxychloroquine against SARS-CoV-2 infection. Int J Antimicrob Agents. 2020;55(5):105960. https://doi.org/10.1016/j.ijantimicag.2020.105960 PMid:32251731 DOI: https://doi.org/10.1016/j.ijantimicag.2020.105960

Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, et al. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis. 2020;71(15):732-9. https://doi.org/10.1093/cid/ciaa237 PMid:32150618 DOI: https://doi.org/10.1093/cid/ciaa237

FDA. Hydroxychloroquine or Chloroquine for COVID-19: Drug Safety Communication-FDA Cautions Against Use Outside of the Hospital Setting or a Clinical Trial Due to Risk of Heart Rhythm Problems. United States: FDA; 2020. Available from: https://www.fda.gov/safety/medical-product-safety-information/hydroxychloroquine-or-chloroquine-covid-19-drug-safety-communication-fda-cautions-against-use [Last accessed on 2020 Aug 07].

Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020;14(1):72-3. https://doi.org/10.5582/BST.2020.01047 PMid:32074550 DOI: https://doi.org/10.5582/bst.2020.01047

Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020;56(1):105949. https://doi.org/10.1016/j.ijantimicag.2020.105949 PMid:32205204 DOI: https://doi.org/10.1016/j.ijantimicag.2020.105949

Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Sevestre J, et al. Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: A pilot observational study. Travel Med Infect Dis. 2020;34:101663. https://doi.org/10.1016/j.tmaid.2020.101663 PMid:32289548 DOI: https://doi.org/10.1016/j.tmaid.2020.101663

Doane DP, Seward LE. Measuring skewness: A forgotten statistic. J Stat Educ. 2011;19:1-18. DOI: https://doi.org/10.1080/10691898.2011.11889611

Shapiro SS, Wilk MB. An analysis of variance test for normality (complete samples). Biometrika. 1965;52:591-611. https://doi.org/10.1093/biomet/52.3-4.591 DOI: https://doi.org/10.1093/biomet/52.3-4.591

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395(10229):1054-62. https://doi.org/10.1016/S0140-6736(20)30566-3 PMid:32171076 DOI: https://doi.org/10.1016/S0140-6736(20)30566-3

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of Coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20. https://doi.org/10.1056/NEJMoa2002032 PMid:32109013 DOI: https://doi.org/10.1056/NEJMoa2002032

Tian W, Jiang W, Yao J, Nicholson CJ, Li RH, Sigurslid HH, et al. Predictors of mortality in hospitalized COVID‐19 patients: A systematic review and meta‐analysis. J Med Virol. 2020;92(10):1875-83. https://doi.org/10.1002/jmv.26050 PMid:32441789 DOI: https://doi.org/10.1002/jmv.26050

Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area. JAMA. 2020;323(20):2052-9. https://doi.org/10.1001/jama.2020.6775 PMid:32320003 DOI: https://doi.org/10.1001/jama.2020.6775

Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al. Clinical Characteristics of COVID-19 in New York City. N Engl J Med. 2020;382(24):2372-4. https://doi.org/10.1056/nejmc2010419 PMid:32302078 DOI: https://doi.org/10.1056/NEJMc2010419

Berenguer J, Ryan P, Rodríguez-Baño J, Jarrín I, Carratalà J, Pachón J, et al. Characteristics and predictors of death among 4,035 consecutively hospitalized patients with COVID-19 in Spain. Clin Microbiol Infect. 2020;26(11):1525-136. https://doi.org/10.1016/j.cmi.2020.07.024 PMid:32758659 DOI: https://doi.org/10.1016/j.cmi.2020.07.024

Brandes RP. Endothelial dysfunction and hypertension. Hypertension. 2014;64(5):924-8. https://doi.org/10.1161/hypertensionaha.114.03575 PMid:25156167 DOI: https://doi.org/10.1161/HYPERTENSIONAHA.114.03575

Avogaro A, Albiero M, Menegazzo L, De Kreutzenberg S, Fadini GP. Endothelial dysfunction in diabetes: The role of reparatory mechanisms. Diabetes Care. 2011;34 Suppl 2:S285-90. https://doi.org/10.2337/dc11-s239 Mid:21525470 DOI: https://doi.org/10.2337/dc11-s239

Zeng F, Huang Y, Guo Y, Yin M, Chen X, Xiao L, et al. Association of inflammatory markers with the severity of COVID-19: A meta-analysis. Int J Infect Dis. 2020;96:467-74. https://doi.org/10.1016/j.ijid.2020.05.055 PMid:32425643 DOI: https://doi.org/10.1016/j.ijid.2020.05.055

Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, et al. Coronavirus infections and immune responses. J Med Virol. 2020;92(4):424-32. https://doi.org/10.1002/jmv.25685 PMid:31981224 DOI: https://doi.org/10.1002/jmv.25685

Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HH, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81(1):e6-12. https://doi.org/10.1016/j.jinf.2020.04.002 PMid:32283162 DOI: https://doi.org/10.1016/j.jinf.2020.04.002

Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARSCoV-2: A prospective cohort study. Eur Respir J. 2020;55(5):2000524. https://doi.org/10.1183/13993003.00524-2020 PMid:32269088 DOI: https://doi.org/10.1183/13993003.00524-2020

Lofgren SM, Nicol MR, Bangdiwala AS, Pastick KA, Skipper CP, Pullen MF, et al. Safety of hydroxychloroquine among outpatient clinical trial participants for COVID-19. Open Forum Infect Dis. 2020;7(11):ofaa500. https://doi.org/10.1101/2020.07.16.20155531 PMid:33204764 DOI: https://doi.org/10.1093/ofid/ofaa500

Lane JC, Weaver J, Kostka K, Duarte-Salles T, Abrahao MT, Alghoul H, et al. Safety of hydroxychloroquine, alone and in combination with azithromycin, in light of rapid wide-spread use for COVID-19: A multinational, network cohort and self-controlled case series study. MedRxiv. 2020;2020:20054551. https://doi.org/10.1101/2020.04.08.20054551 DOI: https://doi.org/10.1101/2020.04.08.20054551

Hu X, Xing Y, Jia J, Ni W, Liang J, Zhao D, et al. Factors associated with negative conversion of viral RNA in patients hospitalized with COVID-19. Sci Total Environ. 2020;728:138812. https://doi.org/10.1016/j.scitotenv.2020.138812 DOI: https://doi.org/10.1016/j.scitotenv.2020.138812