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.
COVID-19; SARS-CoV-2; Mortality; Saudi Arabia
The Corona Virus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first discovered in China in December 2019 and due to unexpected rapid spread and thousands of deaths increasing day by day leading to a heavy burden of hospital admissions and high mortality among hospitalized patients, the World Health Organization (WHO) declared COVID-19 as a pandemic infectious disease on 11th March 2020 [1-3].
The COVID-19 virus is a member of the Coronaviruses family, and its genome shared by 70% and 40% homology to SARS-CoV-2 and MERS-CoV, respectively, which resulted in a widespread epidemic . The COVID-19 virus uses its surface glycoprotein “spike” to bind ACE2 receptors on the respiratory tract’s epithelial cells, accelerating its access into cells and producing thousands of copies . Although the COVID-19 virus principally targets the respiratory system, other system complications as cardiovascular or renal systems can also contribute to death from COVID-19 disease .
The clinical presentation of COVID-19 infection appears to be wide, including asymptomatic infection, mild upper respiratory tract illness, and severe viral pneumonia with respiratory failure and even death . Consequently, early identification of clinical characteristics data and outcomes of COVID-19 patients is fundamental and valuable for the appropriate management and mortality risk reduction to minimize the patients’ suffering and lessen the shortage of medical resources . Numerous case studies describing the clinical characteristics and outcomes of COVID-19 patients have been reported summarizing the experience of the city or regional hospitals and intensive care units (ICU) in different countries. However, population features may vary across the world, even in the same country, affecting the rates for COVID-19 hospitalizations and outcomes . Our study aimed to analyze the clinical and laboratory, and radiological features and detect predictors of the severity and death of hospitalized patients with COVID-19 in King Khalid Hospital, Hail (KK-HH), Saudi Arabia.