Clinical characteristics and risk factors for severe COVID-19 infections in Malaysia: A nationwide observational study
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Updated: Nov 19, 2025
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Benedict Lim Heng Sim1, Suresh Kumar Chidambaram1, Xin Ci Wong2
1Infectious Disease Department, Sungai Buloh Hospital, Malaysia.
Insights
Older age and certain pre-existing conditions significantly increase COVID-19 severity risk. Early hospitalization and mild disease in younger patients contributed to Malaysia
Area of Science:
- Infectious Diseases
- Public Health
- Clinical Medicine
Background:
- COVID-19 (Coronavirus Disease 2019) emerged globally in late 2019, with Malaysia reporting its first case in January 2020.
- Malaysia implemented extensive contact tracing and mandatory hospitalization for all confirmed COVID-19 cases.
- This study aimed to characterize COVID-19 clinical features and identify risk factors for severe disease nationwide.
Purpose of the Study:
- To describe the clinical characteristics of COVID-19 patients in Malaysia.
- To determine risk factors associated with COVID-19 disease severity.
- To analyze outcomes including complications and case fatality rate.
Main Methods:
- Retrospective analysis of clinical records from 5889 RT-PCR confirmed COVID-19 cases (≥12 years) admitted to 18 Malaysian hospitals (Feb 1 - May 30, 2020).
- Data collected included demographics, epidemiological history, comorbidities, clinical presentation, investigations, management, and complications.
- Univariate and multivariate regression analyses were employed to identify determinants of disease severity.
Main Results:
- The study included 5889 cases (median age 34 years, 71.7% male); 92% had mild disease, 3.3% required intensive care.
- Significant determinants for severity included older age (≥51 years), chronic kidney/pulmonary disease, fever, cough, diarrhea, breathlessness, tachypnea, abnormal chest X-rays, and high CRP (≥5 mg/dL).
- The case fatality rate was 1.2%; common complications were liver injury (6.7%), kidney injury (4%), and acute respiratory distress syndrome (2.3%).
Conclusions:
- A lower case fatality rate may be attributed to a younger patient population with mild disease and early hospital admissions.
- Close monitoring within the first five days is crucial for elderly patients presenting with tachypnea and abnormal chest radiographs to anticipate deterioration.
- Identifying risk factors aids in targeted management strategies for severe COVID-19.
Background:
COVID-19 emerged as a major public health outbreak in late 2019. Malaysia reported its first imported case on 25th January 2020, and adopted a policy of extensive contact tracing and hospitalising of all cases. We describe the clinical characteristics of COVID-19 cases nationwide and determine the risk factors associated with disease severity.
Method:
Clinical records of all RT-PCR confirmed COVID-19 cases aged ≥12 years admitted to 18 designated hospitals in Malaysia between 1st February and 30th May 2020 with complete outcomes were retrieved. Epidemiological history, co-morbidities, clinical features, investigations, management and complications were captured using REDCap database. Variables were compared between mild and severe diseases. Univariate and multivariate regression were used to identify determinants for disease severity.
Findings:
The sample comprised of 5889 cases (median age 34 years, male 71.7%). Majority were mild (92%), and 3.3% required intensive care, with 80% admitted within the first five days. Older age (≥51 years), underlying chronic kidney disease and chronic pulmonary disease, fever, cough, diarrhoea, breathlessness, tachypnoea, abnormal chest radiographs and high serum CRP (≥5 mg/dL) on admission were significant determinants for severity (p<0.05). The case fatality rate was 1.2%, and the three commonest complications were liver injuries (6.7%), kidney injuries (4%), and acute respiratory distress syndrome (2.3%).
Interpretations:
Lower case fatality rate was possibly contributed by young cases with mild diseases and early hospitalisation. Abnormal chest radiographic findings in elderly with tachypnoea require close monitoring in the first five days to detect early deterioration.
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