Clinical Aspects and Predictors of Outcome for Hospitalized COVID-19 Patients in Hail, Saudi Arabia

Abstract

Background: As of December 2020, the documented Corona Virus Disease 2019 (COVID-19) cases have almost reached 360,000 with a case fatality of 1.7 percent. In this study, we aimed to identify common presentations and complications of the disease and to assess the mortality predicting factors in hospitalized COVID-19 patients.
Patients and Methods: A retrospective study was conducted between 1st June and 31st August 2020 on the confirmed cases of COVID-19 (using RT-PCR) admitted to King Khalid Hospital, Hail, Saudi Arabia. Adult patients aged 18 years or older who were hospitalized for at least 24 hours with confirmed COVID-19 during the study period were included, while patients with an inadequate past medical history and who were still hospitalized were excluded. Data were collected, coded, and analyzed using SPSS software.
Results: Out of 1466 patients tested by RT-PCR, 404 patients (27.55%) were positive for COVID-19. Out of these 404 patients, 131 (32%) were hospitalized and included in our study with a mean age of 57±16 years, and 74 patients (56.5%) were males. Out of 131 patients, there were 28 deaths (21.4%). The most frequent comorbidities were hypertension (80.9%), diabetes mellitus (67.9%), and chronic kidney disease (39.7%). Fever (95.4%), cough (80.9%), dyspnea (65.6%), and body aches & myalgia (35.9%) were the most common symptoms. The significant predictors of mortality were elevated levels of WBC (AOR= 24.2; p=0.06), BUN (AOR= 31.8; p=0.001), AST (AOR= 11.8; p=0.041), INR (AOR= 11.5; p=0.001), D-Dimer (AOR=10.7; 0.005), lactic acid (AOR= 38.3; p<0.001), and creatinine kinase (AOR=2.1; p<0.001). Decreased lymphocyte count and SPO2 were associated with a high risk of mortality (AOR= 11.9; p=0.037 and AOR= 34.8; p=0.003), respectively. Similarly, patients with COPD were at high risk of mortality (AOR= 18.8; p=0.004).
Conclusion: Among the included patients, the hospitalization mortality rate was 21.4%. Old age and male gender were associated with significant mortality. The independent predictors of COVID-19 mortality were COPD, SPO2<89, acute Liver Injury, leukocytosis, lymphopenia, and markers of inflammation (ESR, CRP, D- Dimer) and shock (lactate, and creatine Kinase). Further studies are needed to assess definite mortality predictors in hospitalized COVID-19 patients to identify and guide patients’ management at risk.