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In-hospital mortality predictors among COVID-19 patients in the West Bank, Palestine: a multi-center retrospective
Hamzeh Al Zabadi1,2, Danyah Khalid2, Ibrahim Taha3
1Master of Public Health Management, Faculty of Graduate Studies, An-Najah National University, Nablus, Palestine.
Insights
Obesity and pregnancy significantly increased COVID-19 mortality in Palestine, with a 43% overall in-hospital death rate. Findings highlight hospital disparities and inform targeted health policies for future pandemics.
Area of Science:
- Public Health
- Epidemiology
- Infectious Diseases
Background:
- The COVID-19 pandemic severely impacted global healthcare, especially in resource-limited regions like Palestine.
- Identifying predictors of in-hospital mortality is vital for improving patient outcomes and resource allocation.
Purpose of the Study:
- To determine demographic, clinical, laboratory, and treatment factors associated with in-hospital mortality in COVID-19 patients in the West Bank, Palestine.
Main Methods:
- Retrospective cohort study of 200 COVID-19 patients hospitalized between November 2020 and February 2021.
- Bivariate and multivariate logistic/Cox regression analyses were used to identify independent predictors of mortality.
Main Results:
- Overall in-hospital mortality was 43%. Obesity (OR=5.73, HR=2.66) was the strongest predictor.
- Higher mortality observed in pregnant patients (81%) and widowed individuals (HR=2.77). Dura Hospital showed higher mortality odds (OR=3.26).
- Non-survivors had lower PaO2, creatinine, and blood sugar. Tocilizumab use correlated with lower mortality, while vancomycin/ceftriaxone use correlated with higher mortality.
Conclusions:
- Key predictors of COVID-19 mortality in Palestine identified, emphasizing prioritization of high-risk groups (obese, pregnant).
- Significant hospital-level disparities in care necessitate standardized treatment protocols.
- Findings support evidence-based health policies for the Palestinian context and pandemic preparedness.
Background:
COVID-19 pandemic has presented unprecedented challenges to global healthcare systems, particularly in resource-limited settings like Palestine. Identifying clinical, demographic, and laboratory predictors of in-hospital mortality is crucial for improving outcomes, guiding treatment, and optimizing resource allocation.
Objectives:
This study aimed to determine the key demographic, clinical, laboratory, and treatment-related factors associated with in-hospital mortality among COVID-19 patients admitted to six governmental hospitals across the West Bank, Palestine.
Methods:
A retrospective cohort design was employed using data from 200 confirmed COVID-19 patients hospitalized between November 1, 2020, and February 1, 2021. Bivariate analyses were conducted using Chi-square and t-tests. Statistically significant variables (p < 0.05) were entered into logistic and Cox regression models to identify independent predictors of mortality and time to death.
Results:
The overall In-hospital mortality rate was 43%. Obesity was the strongest predictor of mortality (OR = 5.73, p < 0.001; HR = 2.66, p < 0.001). Pregnant women showed alarmingly high mortality (81%), though this did not remain significant in multivariate analysis due to small sample size. Widowed patients were significantly more likely to die (HR = 2.77, p = 0.019), emphasizing the role of social support. Hospital type was another independent predictor, with patients at Dura Hospital experiencing higher odds of death (OR = 3.26, p = 0.017). Key laboratory findings included significantly lower PaO2, serum creatinine, and random blood sugar levels among non-survivors. Actemra (tocilizumab) use was associated with significantly lower mortality (0% vs. 46%, p = 0.001), while vancomycin and ceftriaxone were associated with higher mortality, likely reflecting use in severe cases.
Conclusions:
This study identified key predictors of COVID-19 mortality in Palestine, emphasizing the need to prioritize high-risk groups such as obese and pregnant patients. The findings highlight disparities between hospitals and reinforce the importance of standardizing care across healthcare facilities. These insights can help shape evidence-based health policies tailored to the Palestinian context and could serve as a foundational dataset for preparedness in future pandemics or resurgences of COVID-19.
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