Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospital
Background: Coronavirus disease 2019 (COVID-19) has resulted in millions of deaths, including more than 6000 deaths in the Kingdom of Saudi Arabia (KSA). Identifying key predictors of intensive care unit (ICU) admission and mortality among infected cases would help in identifying individuals at risk...
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Elsevier
2021-11-01
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Series: | Journal of Infection and Public Health |
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Online Access: | http://www.sciencedirect.com/science/article/pii/S1876034121003142 |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mazin Barry Muath Alotaibi Abdulellah Almohaya Abdulwahab Aldrees Ali AlHijji Nouf Althabit Sara Alhasani Layan Akkielah Abdulaziz AlRajhi Thamer Nouh Mohamad-Hani Temsah Jaffar A. Al-Tawfiq |
spellingShingle |
Mazin Barry Muath Alotaibi Abdulellah Almohaya Abdulwahab Aldrees Ali AlHijji Nouf Althabit Sara Alhasani Layan Akkielah Abdulaziz AlRajhi Thamer Nouh Mohamad-Hani Temsah Jaffar A. Al-Tawfiq Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospital Journal of Infection and Public Health COVID-19 Risk factors ICU Invasive mechanical ventilation |
author_facet |
Mazin Barry Muath Alotaibi Abdulellah Almohaya Abdulwahab Aldrees Ali AlHijji Nouf Althabit Sara Alhasani Layan Akkielah Abdulaziz AlRajhi Thamer Nouh Mohamad-Hani Temsah Jaffar A. Al-Tawfiq |
author_sort |
Mazin Barry |
title |
Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospital |
title_short |
Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospital |
title_full |
Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospital |
title_fullStr |
Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospital |
title_full_unstemmed |
Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospital |
title_sort |
factors associated with poor outcomes among hospitalized patients with covid-19: experience from a mers-cov referral hospital |
publisher |
Elsevier |
series |
Journal of Infection and Public Health |
issn |
1876-0341 |
publishDate |
2021-11-01 |
description |
Background: Coronavirus disease 2019 (COVID-19) has resulted in millions of deaths, including more than 6000 deaths in the Kingdom of Saudi Arabia (KSA). Identifying key predictors of intensive care unit (ICU) admission and mortality among infected cases would help in identifying individuals at risk to optimize their care. We aimed to determine factors of poor outcomes in hospitalized patients with COVID-19 in a large academic hospital in Riyadh, KSA that serves as a Middle East Respiratory Syndrome coronavirus (MERS-CoV) referral center. Methods: This is a single-center retrospective cohort study of hospitalized patients between March 15 and August 31, 2020. The study was conducted at King Saud University Medical City (KSUMC). COVID-19 infection was confirmed using real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-COV-2. Demographic data, clinical characteristics, laboratory, radiological features, and length of hospital stay were obtained. Poor outcomes were, admission to ICU, need for invasive mechanical ventilation (IMV), and in-hospital all-cause mortality. Results: Out of 16,947 individuals tested in KSUMC, 3480 (20.5%) tested positive for SARS-CoV-2 and of those 743 patients (21%) were hospitalized. There were 62% males, 77% were younger than 65 years. Of all cases, 204 patients (28%) required ICU admission, 104 (14%) required IMV, and 117 (16%) died in hospital. In bivariate analysis, multiple factors were associated with mortality among COVID-19 patients. Further multivariate analysis revealed the following factors were associated with mortality: respiratory rate more than 24/min and systolic blood pressure <90 mmHg in the first 24 h of presentation, lymphocyte count <1 × 109/L and aspartate transaminase level >37 units/L in the first 48 h of presentation, while a RT-PCR cycle threshold (Ct) value ≤24 was a predictor for IMV. Conclusion: Variable factors were identified as predictors of different outcomes among COVID-19 patients. The only predictor of IMV was a low initial Ct values of SARS-CoV-2 PCR. The presence of tachypnea, hypotension, lymphopenia, and elevated AST in the first 48 h of presentation were independently associated with mortality. This study provides possible independent predictors of mortality and invasive mechanical ventilation. The data may be helpful in the early identification of high-risk COVID-19 patients in areas endemic with MERS-CoV. |
topic |
COVID-19 Risk factors ICU Invasive mechanical ventilation |
url |
http://www.sciencedirect.com/science/article/pii/S1876034121003142 |
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doaj-35ab34b042df4941a320a2f624fa88a92021-10-09T04:37:15ZengElsevierJournal of Infection and Public Health1876-03412021-11-01141116581665Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospitalMazin Barry0Muath Alotaibi1Abdulellah Almohaya2Abdulwahab Aldrees3Ali AlHijji4Nouf Althabit5Sara Alhasani6Layan Akkielah7Abdulaziz AlRajhi8Thamer Nouh9Mohamad-Hani Temsah10Jaffar A. Al-Tawfiq11Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Corresponding author at: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, PO Box 2925, Riyadh 11461, Saudi Arabia.Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi ArabiaDivision of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Internal Medicine Department, Ad-Dariya Hospital, Ministry of Health, Riyadh, Saudi ArabiaDivision of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi ArabiaDivision of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi ArabiaDivision of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi ArabiaDivision of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi ArabiaDivision of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi ArabiaDivision of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi ArabiaTrauma and Acute Care Surgery Unit, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCritical Care Unit, Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi ArabiaSpecialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USABackground: Coronavirus disease 2019 (COVID-19) has resulted in millions of deaths, including more than 6000 deaths in the Kingdom of Saudi Arabia (KSA). Identifying key predictors of intensive care unit (ICU) admission and mortality among infected cases would help in identifying individuals at risk to optimize their care. We aimed to determine factors of poor outcomes in hospitalized patients with COVID-19 in a large academic hospital in Riyadh, KSA that serves as a Middle East Respiratory Syndrome coronavirus (MERS-CoV) referral center. Methods: This is a single-center retrospective cohort study of hospitalized patients between March 15 and August 31, 2020. The study was conducted at King Saud University Medical City (KSUMC). COVID-19 infection was confirmed using real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-COV-2. Demographic data, clinical characteristics, laboratory, radiological features, and length of hospital stay were obtained. Poor outcomes were, admission to ICU, need for invasive mechanical ventilation (IMV), and in-hospital all-cause mortality. Results: Out of 16,947 individuals tested in KSUMC, 3480 (20.5%) tested positive for SARS-CoV-2 and of those 743 patients (21%) were hospitalized. There were 62% males, 77% were younger than 65 years. Of all cases, 204 patients (28%) required ICU admission, 104 (14%) required IMV, and 117 (16%) died in hospital. In bivariate analysis, multiple factors were associated with mortality among COVID-19 patients. Further multivariate analysis revealed the following factors were associated with mortality: respiratory rate more than 24/min and systolic blood pressure <90 mmHg in the first 24 h of presentation, lymphocyte count <1 × 109/L and aspartate transaminase level >37 units/L in the first 48 h of presentation, while a RT-PCR cycle threshold (Ct) value ≤24 was a predictor for IMV. Conclusion: Variable factors were identified as predictors of different outcomes among COVID-19 patients. The only predictor of IMV was a low initial Ct values of SARS-CoV-2 PCR. The presence of tachypnea, hypotension, lymphopenia, and elevated AST in the first 48 h of presentation were independently associated with mortality. This study provides possible independent predictors of mortality and invasive mechanical ventilation. The data may be helpful in the early identification of high-risk COVID-19 patients in areas endemic with MERS-CoV.http://www.sciencedirect.com/science/article/pii/S1876034121003142COVID-19Risk factorsICUInvasive mechanical ventilation |