Clinical features and risk factors associated with morbidity and mortality among patients with COVID-19 in northern Ethiopia

• Main Authors: Hiluf Ebuy Abraha, Zekarias Gessesse, Teklay Gebrecherkos, Yazezew Kebede, Aregawi Weldegebreal Weldegiargis, Mengistu Hagazi Tequare, Abadi Luel Welderufael, Dawit Zenebe, Asqual Gebreslassie Gebremariam, Tsega Cherkos Dawit, Daniel Woldu Gebremedhin, Tobias Rinke de Wit, Dawit Wolday
• Format: Article
• Language: English
• Published: Elsevier 2021-04-01
• Series: International Journal of Infectious Diseases
• Subjects: COVID-19; Africa; Comorbidities; Clinical features; Ethiopia; SARS-CoV-2
• Online Access: http://www.sciencedirect.com/science/article/pii/S1201971221002551

Objective: To describe the clinical features and assess the determinants of severity and in-hospital mortality of patients with coronavirus disease 2019 (COVID-19) from a unique setting in Ethiopia. Methods: Consecutive patients admitted to a COVID-19 isolation and treatment centre were included in this study. The overall clinical spectrum of COVID-19, and factors associated with risk of severe COVID-19 and in-hospital mortality were analysed. Results: Of 2617 quarantined patients, three-quarters (n = 1935, 74%) were asymptomatic and only 114 (4.4%) presented with severe COVID-19. Common characteristics among the 682 symptomatic patients were cough (n = 354, 50.6%), myalgia (n = 212, 31.1%), headache (n = 196, 28.7%), fever (n = 161, 23.6%), dyspnoea (n = 111, 16.3%), anosmia and/or dysgeusia (n = 90, 13.2%), sore throat (n = 87, 12.8%) and chest pain (n = 77, 11.3%). Factors associated with severe COVID-19 were older age [adjusted relative risk (aRR) 1.78, 95% confidence interval (CI) 1.61–1.97; P < 0.0001], diabetes (aRR 2.00, 95% CI 1.20–3.32; P = 0.007), cardiovascular disease (aRR 2.53, 95% CI 1.53–4.17; P < 0.0001), malignancy (aRR 4.57, 95% CI 1.62–12.87; P = 0.004), surgery/trauma (aRR 23.98, 95% CI 10.35–55.57; P < 0.0001) and human immunodeficiency virus infection (aRR 4.24, 95% CI 1.55–11.61; P = 005). Factors associated with risk of in-hospital mortality included older age (aRR 2.37, 95% CI 1.90–2.95; P < 0.001), malignancy (aRR 6.73, 95% CI 1.50–30.16; P = 0.013) and surgery/trauma (aRR 59.52, 95% CI 12.90–274.68; P < 0.0001). Conclusions: A significant proportion of cases of COVID-19 were asymptomatic, and key comorbid conditions increased the risk of severe COVID-19 and in-hospital mortality. These findings could help in the design of appropriate management strategies for patients.