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Factors Associated with 30-Day in-Hospital Mortality Among Patients Admitted with Severe Covid-19 in Mbarara Regional
Andrew Mutekanga1, Edwin Nuwagira1, Elias Kumbakumba2
1Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Insights
Severe COVID-19 patients in Uganda faced high mortality rates. Older age, high neutrophil-to-lymphocyte ratio, and high oxygen needs were linked to increased 30-day in-hospital deaths.
Area of Science:
- Infectious Diseases
- Epidemiology
- Critical Care Medicine
Background:
- COVID-19 poses a significant global healthcare burden, with severe cases associated with high in-hospital mortality.
- Limited data exists on 30-day in-hospital mortality and its associated factors in southwestern Uganda.
- Severe COVID-19 outcomes require further investigation in under-resourced regions.
Purpose of the Study:
- To determine the 30-day in-hospital mortality rate among severe COVID-19 patients in southwestern Uganda.
- To identify clinical and laboratory factors associated with 30-day in-hospital mortality in this population.
- To inform early identification of high-risk patients for improved clinical management.
Main Methods:
- A retrospective, single-center cohort study was conducted at Mbarara Regional Referral Hospital.
- Inclusion criteria: in-patients with severe COVID-19 admitted between April 2020 and September 2021.
- Logistic regression analysis was used to identify factors associated with 30-day mortality.
Main Results:
- The overall 30-day in-hospital mortality rate for severe COVID-19 was 48% (134 of 279 patients).
- Factors significantly associated with increased mortality included age (≥65 years), neutrophil-to-lymphocyte ratio (>5), and oxygen requirement (≥15L/min).
- Non-survivors had a shorter median hospital stay compared to survivors (5 days vs. 8 days).
Conclusions:
- A high 30-day in-hospital mortality rate was observed in severe COVID-19 patients in southwestern Uganda.
- Age, elevated neutrophil-to-lymphocyte ratio, and high oxygen requirement are critical indicators of poor prognosis.
- These findings can aid clinicians in early risk stratification and management of severe COVID-19 patients.
Background:
COVID-19 has created a burden on the healthcare system globally. Severe COVID-19 is linked with high hospital mortality. Data regarding 30-day in-hospital mortality and its factors has not been explored in southwestern Uganda.
Methods:
We carried out a retrospective, single-center cohort study, and included all in-patients with laboratory-confirmed, radiological, or clinical severe COVID-19 admitted between April 2020 and September 2021 at Mbarara Regional Referral Hospital (MRRH). Demographic, laboratory, treatment, and clinical outcome data were extracted from patients' files. These data were described comparing survivors and non-survivors. We used logistic regression to explore the factors associated with 30-day in-hospital mortality.
Results:
Of the 283 patients with severe COVID-19 admitted at MRRH COVID-19 unit, 58.1% were male. The mean age ± standard deviation (SD) was 61±17.4 years; there were no differences in mean age between survivors and non-survivors (59 ± 17.2 versus 64.4 ±17.3, respectively, p=0.24) The median length of hospital stay was 7 (IQR 3-10) days (non-survivors had a shorter median length of stay 5 (IQR 2-9) days compared to the survivors; 8 (IQR 5-11) days, p<0.001. The most frequent comorbidities were hypertension (30.5%) and diabetes mellitus (30%). The overall 30-day in-hospital mortality was 134 of 279 (48%) mortality rate of 47,350×105 with a standard error of 2.99%. The factors associated with 30-day in-hospital mortality were age: 65 years and above (aOR, 3.88; 95% CI, 1.24-11.70; P =0.020) a neutrophil to lymphocyte ratio above 5 (aOR, 4.83; 95% CI, 1.53-15.28; P =0.007) and oxygen requirement ≥15L/min (aOR, 15.80; 95% CI, 5.17-48.25; P <0.001).
Conclusion:
We found a high 30-day in-hospital mortality among patients with severe forms of COVID-19. The identified factors could help clinicians to identify patients with poor prognosis at an early stage of admission.
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