Survival of COVID-19 among the Iranian population before and after the Delta variant spread 10.55131/jphd/2023/210201
Article Sidebar
Main Article Content
Abstract
COVID-19 has been considered the most important issue in the last two years. Some characteristics and factors can play a pivotal role in the survival time and mortality of COVID-19 patients. The Delta variant was one of the most important variants of COVID-19. This study aimed to investigate the risk factors of COVID-19 survival before and after the spread of the Delta variant. In this historical cohort study, 6,117 hospitalized patients with positive COVID-19 PCR tests between January and September 2021 participated. Some characteristics such as age, sex, death by COVID-19, and presence/absence of some comorbidities were registered for the patients. Log-rank test and Cox proportional hazards model were done to check the effect of the potential risk factors on the survival of COVID-19 patients by considering the onset of symptoms to death as the time variable. The mean age of patients was 47.29 (SD=18.70). 53% of patients were female, 4.6% were admitted to the ICU, and 3.6% died from COVID-19. Age (HR=9.81, p<.001), cardiovascular disease (HR=2.86, p<.001), chronic kidney disease (HR=6.21, p<.001), diabetes (HR=2.16, p=0.002), hypertension (HR=2.67, p<.001), ICU admission (HR=12.92, p<.001), pO2<93% (HR=6.75, p<.001), and intubation (HR=21.54, P<.001) were risk factors that were influential on the survival of COVD-19 patients before the spread of the Delta variant. Although the effect of some variables changed after the spread of the Delta variant, some of them, like chronic kidney disease and hypertension were no longer significant. Although the effect of some comorbidities was significant only in the crude models, they were not influential in the adjusted model. Conversely, in the presence of other risk factors, especially age, most of the comorbidities were not significant in the adjusted model. Older age, ICU admission, intubation, and pO2<93% are the most important variables which played a pivotal role in the survival of individuals infected by COVID-19.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Heidarijamebozorgi M, Jafari H, Sadeghi R, Sheikhbardsiri H, Kargar M, Amiri Gharaghani M. The prevalence of depression, anxiety, and stress among nurses during the coronavirus disease 2019: a comparison between nurses in the frontline and the second line of care delivery. Nurs. Midwifery Stud. 2021;10(3):188-93.
World Health Organization. Coronavirus [Internet]. [Cited 2021 December 10]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
worldometer. COVID-19 CORONAVIRUS PANDEMIC [Internet]. [Cited 2021 October 5]. Available from: https://www. worldometers.info/coronavirus/?utm_campaign=homeAdvegas1.
WHO Coronavirus (COVID-19) Dashboard: World Health Organization [Internet]. [Cited 2021 November 1]. Available from: https://covid19. who.int/.
Ma Y, Xu QN, Wang FL, Ma XM, Wang XY, Zhang XG, et al. Characteristics of asymptomatic patients with SARS-CoV-2 infection in Jinan, China. Microbes Infect. 2020;22(4-5):212-7.
Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13): 1239-42.
C.f.D. Control and Prevention. SARS-CoV-2 variant classifications and definitions [Internet]. [Cited 2021 March 21]. Available from: https:// www.cdc.gov/coronavirus/2019-ncov/ variants/variant-classifications.html.
Roy B, Dhillon J, Habib N, Pugazhandhi B. Global variants of COVID-19: Current understanding. J. Biomed. Sci. 2021;8(1):8-11.
World Health Organization. Tracking SARS-CoV-2 variants 2021 [Internet]. [Cited 2021 December 23]. Available from: https://www.who.int/en/ activities/tracking-SARS-CoV-2-variants/.
World Health Organization. COVID-19 weekly epidemiological update [Internet]. 2020. [Cited 2021 June 20]. Available from: https://www.who. int/publications/m/item/weekly-epidemiological-update-on-covid-19---7-september-2022.
Fattahi Z, Mohseni M, Beheshtian M, Jafarpour A, Jalalvand K, Keshavarzi F, et al. Disease waves of SARS-CoV-2 in Iran closely mirror global pandemic trends. medRxiv. 2021:2021.10.23. 21265086.
Chen L, Zhang B, Ti MN, Yang K, Zou Y, Zhang S. Clinical course of severe and critically ill patients with coronavirus disease 2019 (COVID-19): A comparative study. J Infect. 2020; 81(2):e82-e4.
Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J. Infect. 2020;81(2):e16-e25.
Nikpouraghdam M, Jalali Farahani A, Alishiri G, Heydari S, Ebrahimnia M, Samadinia H, et al. Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study. J Clin Virol. 2020;127:104378.
Bouya S, Balouchi A, Rafiemanesh H, Hesaraki M. Prevalence of Chronic Kidney Disease in Iranian General Population: A Meta-Analysis and Systematic Review. Ther Apher Dial. 2018;22(6):594-9.
Esteghamati A, Larijani B, Aghajani MH, Ghaemi F, Kermanchi J, Shahrami A, et al. Diabetes in Iran: Prospective Analysis from First Nationwide Diabetes Report of National Program for Prevention and Control of Diabetes (NPPCD-2016). Sci Rep. 2017;7(1): 13461.
Sarrafzadegan N, Mohammmadifard N. Cardiovascular Disease in Iran in the Last 40 Years: Prevalence, Mortality, Morbidity, Challenges and Strategies for Cardiovascular Prevention. Arch Iran Med. 2019;22(4):204-10.
Cetin S, Ulgen A, Balci PO, Sivgin H, Cetin M, Sivgin S, et al. Survival analyses of COVID-19 patients in a Turkish cohort: comparison between using time to death and time to release. SciMedicine Journal. 2021;3:1-9. doi: 10.28991/SciMedJ-2021-03-SI-1
Galbadage T, Peterson BM, Awada J, Buck AS, Ramirez DA, Wilson J, et al. Systematic Review and Meta-Analysis of Sex-Specific COVID-19 Clinical Outcomes. Front Med (Lausanne). 2020;7:348.
Galvão MHR, Roncalli AG. Factors associated with increased risk of death from covid-19: a survival analysis based on confirmed cases. Rev Bras Epidemiol. 2021;23:e200106.
Liu Y, Sun W, Li J, Chen L, Wang Y, Zhang L, et al. Clinical features and progression of acute respiratory distress syndrome in coronavirus disease 2019. medRxiv. 2020:2020.02.17.20024166. doi: https://doi.org/10.1101/2020.02. 17.20024166
Nijman G, Wientjes M, Ramjith J, Janssen N, Hoogerwerf J, Abbink E, et al. Risk factors for in-hospital mortality in laboratory-confirmed COVID-19 patients in the Netherlands: A competing risk survival analysis. PLOS One. 2021;16(3):e0249231. doi: 10.1371/journal.pone.0249231
Salinas-Escudero G, Carrillo-Vega MF, Granados-García V, Martínez-Valverde S, Toledano-Toledano F, Garduño-Espinosa J. A survival analysis of COVID-19 in the Mexican population. BMC Public Health. 2020;20(1):1616. doi: 10.1186/s12889-020-09721-2
Sousa GJB, Garces TS, Cestari VRF, Florêncio RS, Moreira TMM, Pereira MLD. Mortality and survival of COVID-19. Epidemiol Infect. 2020; 148:e123. doi: 10.1017/ S0950268820001405
Thai PQ, Toan DTT, Son DT, Van HTH, Minh LN, Hung LX, et al. Factors associated with the duration of hospitalisation among COVID-19 patients in Vietnam: A survival analysis. Epidemiol Infect. 2020; 148:e114. doi: 10.1017/S09502688 20001259
Nikpouraghdam M, Jalali Farahani A, Alishiri G, Heydari S, Ebrahimnia M, Samadinia H, et al. Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study. J Clin Virol. 2020;127:104378. doi: 10.1016/j.jcv. 2020.104378
Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-38. doi: 10.1016/j.kint. 2020.03.005
Zareifopoulos N, Lagadinou M, Karela A, Platanaki C, Karantzogiannis G, Velissaris D. Management of COVID-19: the risks associated with treatment are clear, but the benefits remain uncertain. Monaldi Arch Chest Dis. 2020;90(2). doi: 10.4081/monaldi. 2020.1342