Risk factors and clinical features associated with death at the COVID-19 isolation ward of Clairwood Hospital/KwaZulu-Natal, South Africa: A retrospective case-control study. 10.55131/jphd/2026/240314
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Abstract
The COVID-19 pandemic posed significant challenges to healthcare systems worldwide. This study aimed to investigate the risk factors associated with death among patients admitted directly to the COVID-19 isolation ward at Clairwood Hospital. A case-control study was undertaken, involving a total of 400 study participants divided equally into 200 cases (deaths) and 200 controls (survivors). Data were collected retrospectively from medical records and analysed using Chi-square tests, univariate, and multivariate logistic regression. The patients had a mean age of 54.1 years (SD=18.9), with 217(54.2%) being female. A respiratory rate exceeding 20 breaths per minute was documented in 177 patients (44.2%), a heart rate greater than 100 beats per minute in 99 patients (24.7%), and a SpO₂ level below 85% on room air in 79 patients (19.7%). Cough was the most common symptom, occurring in 239 (59.7%) patients, while hypertension was the most prevalent comorbidity, present in 157 (39.2%) patients at the time of admission. Chi-square test analyses demonstrated statistically significant associations between mortality and age, fever, cough, shortness of breath, hypertension, diabetes, chronic kidney disease (CKD), obesity, respiratory rate, heart rate, and oxygen saturation (SpO₂) (all p < 0.05). On multivariate analysis, increasing age (adjusted odds ratio [aOR]: > 60 years: 12.27 [95% CI: 1.27–118.44]), fever (aOR: 2.86 [95% CI: 1.29–6.31]), shortness of breath (aOR: 9.86 [95% CI: 5.64–17.24]), hypertension (aOR: 2.07 [95% CI: 1.05–4.11]), obesity (aOR: 4.68 [95% CI: 1.43–15.28]), were associated with increased odds of death among COVID-19 patients at admission. No statistically significant associations were observed for other variables after adjustment. Proactive measures to identify and manage these risk factors are crucial in reducing mortality rates and enhancing the overall care of COVID-19 patients in isolation wards.
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References
Phelan AL, Katz R, Gostin LO. The novel coronavirus originating in Wuhan, China: challenges for global health governance. JAMA. 2020; 323(8):709–710. doi:10.1001/jama. 2020.1097
World Health Organization. Coronavirus disease (COVID-19) dashboard [Internet]. [cited 2023 Aug 9]. Available from: https://covid19. who.int/
Richardson S, Gitlin J, Kozel Z, Levy S, Rahman H, Hirsch JS, et al. In-hospital 30-day survival among young adults with coronavirus disease 2019: a cohort study. Open Forum Infect Dis. 2021;8(6):ofab233. doi:10.1093/ofid/ ofab233
Meisenberg BR, Qureshi S, Somasekar MT, Ali Q, Karpman M, Rhule J. COVID-19 mortality in an acute care hospital: association of patient factors with decision to forego the intensive care unit. Am J Hosp Palliat Med. 2022;39(4):481–486. doi:10.1177/ 10499091211062205
Manimani RG, Willy TM, Nombulelo M. Risk factors for death in hospitalized COVID-19 patients in Africa: a systematic review and meta-analysis. Medicine (Baltimore). 2023; 102(38):e34405. doi:10.1097/MD. 0000000000034405
Bepouka BI, Mandina M, Makulo JR, Longokolo M, Odio O, Mayasi N, et al. Predictors of mortality in COVID-19 patients at Kinshasa University Hospital, Democratic Republic of the Congo, from March to June 2020. Pan Afr Med J. 2020;37:105. doi: 10.11604/pamj.2020.37.105.25167
Allwood BW, Koegelenberg CF, Ngah VD, Sigwadhi LN, Irusen EM, Lalla U, et al. Predicting COVID-19 outcomes from clinical and laboratory parameters in an intensive care facility during the second wave of the pandemic in South Africa. Int J Infect Dis Reg. 2022;3:242–247. doi: 10.1016/j.ijregi.2022.03.012
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi:10.1016/S0140-6736(20)30183-5
Zhang B, Zhou X, Zhu C, Song Y, Feng F, Qiu Y, et al. Immune phenotyping based on the neutrophil-to-lymphocyte ratio and IgG level predicts disease severity and outcome for patients with COVID-19. Front Mol Biosci. 2020;7:157. doi: 10.3389/fmolb.2020.00157
Jassat W, Cohen C, Tempia S, Masha M, Goldstein S, Kufa T, et al. COVID-19 in-hospital mortality in South Africa: the intersection of communicable and non-communicable chronic diseases in a high HIV prevalence setting. Lancet HIV. 2020;7(9):e645–e654. doi:10.1016/S2352-3018(20)30241-1
Animut Z, Bedimo M, Bitew A, Fenta S, Menegist A. Determinants of death among COVID-19 patients admitted in Amhara Region COVID-19 Treatment Centers, Ethiopia, 2021: unmatched case-control study. J Infect Dis Epidemiol. 2022;8:252. doi:10.23937/ 2474-3658/1510252
Krishnan A, Kumar R, Amarchand R, Mohan A, Kant R, Agarwal A, et al. Predictors of mortality among patients hospitalized with COVID-19 during the first wave in India: a multisite case-control study. Am J Trop Med Hyg. 2023;108(4):727–734. doi:10.4269/ ajtmh.22-0596
Bajaj V, Gadi N, Spihlman AP, Wu SC, Choi CH, Moulton VR. Aging, immunity, and COVID-19: how age influences the host immune response to coronavirus infections. Front Physiol. 2021;11:571416. doi:10.3389/fphys.2020.571416
Dessie ZG, Zewotir T. Mortality-related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423,117 patients. BMC Infect Dis. 2021;21(1):855. doi: 10.1186/s12879-021-06536-3
Chen Y, Klein SL, Garibaldi BT, Li H, Wu C, Osevala NM, et al. Aging in COVID-19: vulnerability, immunity and intervention. Ageing Res Rev. 2021;65:101205. doi:10.1016/j.arr. 2020.101205
Klein SL, Pekosz A, Park HS, Ursin RL, Shapiro JR, Benner SE, et al. Sex, age, and hospitalization drive antibody responses in a COVID-19 convalescent plasma donor population. J Clin Invest. 2020;130(11):6141–6150. doi:10.1172/JCI140754
Fung SY, Yuen KS, Ye ZW, Chan CP, Jin DY. A tug-of-war between severe acute respiratory syndrome coronavirus 2 and host antiviral defence: lessons from other pathogenic viruses. Emerg Microbes Infect. 2020;9(1):558–570. doi:10.1080/22221751.2020.1736644
Nasiri MJ, Haddadi S, Tahvildari A, Farsi Y, Arbabi M, Hasanzadeh S, et al. COVID-19 clinical characteristics, and sex-specific risk of mortality: systematic review and meta-analysis. Front Med (Lausanne). 2020;7:459. doi:10.3389/fmed.2020.00459
Tian W, Jiang W, Yao J, Nicholson CJ, Li RH, Sigurslid HH, et al. Predictors of mortality in hospitalized COVID-19 patients: a systematic review and meta-analysis. J Med Virol. 2020;92(10):1875–1883. doi:10.1002/jmv.26050
Franceschi C, Garagnani P, Parini P, Giuliani C, Santoro A. Aging, inflammaging and immunosenescence as risk factors of severe COVID-19. Immunity & Ageing. 2022;19:27. doi: 10.1186/s12979-022-00309-5
Sousa GJ, Garces TS, Cestari VR, Florêncio RS, Moreira TM, Pereira ML. Mortality and survival of COVID-19. Epidemiol Infect. 2020;148:e123. doi:10.1017/S0950268820001235
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. doi:10.1016/S0140-6736(20)30566-3
Abebe HT, Mulugeta A, Berhe Y, Berhane K, Siraj A, Siraj D, et al. Risk factors for mortality among hospitalized COVID-19 patients in Northern Ethiopia: a retrospective analysis. PLoS One. 2022;17(8): e0271124. doi:10.1371/journal.pone. 0271124
Poissy J, Goutay J, Caplan M, Parmentier E, Duburcq T, Lassalle F, et al. Pulmonary embolism in patients with COVID-19: awareness of an increased prevalence. Circulation. 2020;142(2):184–186. doi:10.1161/ CIRCULATIONAHA.120.047430
Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020;395(10239):1763–1770. doi:10.1016/S0140-6736(20)31189-2
Mehraeen E, Karimi A, Barzegary A, Vahedi F, Afsahi AM, Dadras O, et al. Predictors of mortality in patients with COVID-19 – a systematic review. Eur J Integr Med. 2020;40:101226. doi:10.1016/j.eujim.2020.101226
Tartof SY, Qian L, Hong V, Wei R, Nadjafi RF, Fischer H, et al. Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization. Ann Intern Med. 2020; 173(10):773–781. doi:10.7326/M20-3742
Tavares CAM, Bailey K, Girardi SN. Biological context linking hypertension and higher risk for COVID‑19 severity. Front Physiol. 2020;11:599729. doi:10.3389/fphys. 2020.599729
Muhamad SA, Ugusman A, Kumar J, Skiba D, Hamid AA, Aminuddin A. COVID-19 and hypertension: the what, the why, and the how. Front Physiol. 2021;12:665064. doi:10.3389/ fphys.2021.665064
Lanza K, Perez LG, Costa LB, Cordeiro TM, Palmeira VA, Ribeiro VT, et al. COVID-19: the renin–angiotensin system imbalance hypothesis. Clin Sci (Lond). 2020; 134(11):1259–1264. doi:10.1042/CS20200613
Costa LB, Perez LG, Palmeira VA, Macedo e Cordeiro T, Ribeiro VT, Lanza K, et al. Insights on SARS-CoV-2 molecular interactions with the renin-angiotensin system. Front Cell Dev Biol. 2020;8:559841. doi:10.3389/ fcell.2020.559841
Cajanding RJ. Current state of knowledge on the definition, pathophysiology, etiology, outcomes, and management of fever in the intensive care unit. AACN Adv Crit Care. 2023;34(4):297–310. doi: 10.4037/aacnacc2023326
Blon L, Skidmore P, Mehra R, Walter E. Effect of a fever in viral infections—the ‘Goldilocks’ phenomenon? World J Clin Cases. 2021;9(2):296–303. doi:10.12998/wjcc.v9.i2.296
g DH, Choy CY, Chan YH, Young BE, Fong SW, Ng LF, Renia L, Lye DC, Chia PY. Fever patterns, cytokine profiles, and outcomes in COVID-19. Open Forum Infect Dis. 2020;7(9):ofaa
