Competing Risk Survival Analysis of Time to In-Hospital Recovery or Death Among COVID-19 Patients: A Hospital-Based...

In-hospital death and recovery are competing risks in COVID-19 patients, complicating prognosis. While international prognostic scores exist, their reliance on complex biomarkers limits their utility in resource-constrained settings. This study aimed to estimate the duration and identify determinants of in-hospital outcomes in southeast Ethiopia and to develop a clinically accessible risk stratification tool.

Data from 827 confirmed COVID-19 patients (October 2022-May 2023) across six treatment centers were analyzed using the Fine-Gray Competing Risk Survival Analysis (CRSA). Additionally, a novel "Asella COVID-19 Risk Score" was developed using readily available bedside clinical parameters (age, comorbidity, and antibiotic use) and validated using receiver operating characteristic analysis.

Overall, 139/827 (17%) died, and 516/827 (62%) recovered. Risk of death was significantly higher for patients aged ≥ 50 years (acsHR = 2.62; 95%CI: 1.29, 5.29; p < 0.001) and those with an immunocompromised state (acsHR= 1.46; 95%CI: 1.08, 1.98; p = 0.014). Median time to death was 5 days. The "Asella COVID-19 Risk Score" demonstrated an area under the curve of 0.65. At an optimal cutoff of ≥ 4, the score achieved a sensitivity of 47.2%, specificity of 73.2%, and a high negative predictive value (NPV) of 83.5%.

Advanced age and immunocompromised status significantly increase mortality risk. The Asella COVID-19 Risk Score provides a clinically validated, high-NPV triage tool suitable for resource-limited settings, facilitating the early identification of high-risk patients and more efficient resource allocation.