tetano
Editor, Senior Moderator
Sci Rep
. 2024 Aug 30;14(1):20205.
doi: 10.1038/s41598-024-70662-6. Risk factors for mortality in hospitalized COVID-19 patients across five waves in Pakistan
Nosheen Nasir[SUP] 1 [/SUP], Salma Tajuddin[SUP] 2 [/SUP], Afshan Akhtar[SUP] 3 [/SUP], Chanza Fahim Sheikh[SUP] 2 [/SUP], Adil Al Karim Manji[SUP] 3 [/SUP], Shameen Bhutto[SUP] 3 [/SUP], Naveera Khan[SUP] 3 [/SUP], Adnan Khan[SUP] 3 [/SUP], Muhammad Faisal Khan[SUP] 4 [/SUP], Syed Faisal Mahmood[SUP] 2 [/SUP], Bushra Jamil[SUP] 2 [/SUP], Iffat Khanum[SUP] 2 [/SUP], Kiren Habib[SUP] 2 [/SUP], Asad Latif[SUP] 4 [/SUP], Zainab Samad[SUP] 2 [/SUP], Adil H Haider[SUP] 3 [/SUP]
Affiliations
This retrospective cohort study aims to describe the clinical characteristics and outcomes and assess risk factors for mortality across the epidemic waves in hospitalized COVID-19 patients in a major tertiary-care center in Pakistan. A total of 5368 patients with COVID-19, hospitalized between March 2020 and April 2022 were included. The median age was 58 years (IQR: 44-69), 41% were females, and the overall mortality was 12%. Comparative analysis of COVID-19 waves showed that the proportion of patients aged ≥ 60 years was highest during the post-wave 4 period (61.4%) and Wave 4 (Delta) (50%) (p < 0.001). Male predominance decreased from 65.2% in Wave 2 to 44.2% in Wave 5 (Omicron) (p < 0.001). Mortality rate was lowest at 9.4% in wave 5 and highest at 21.6% in the post-wave 4 period (p = 0.041). In multivariable analysis for risk factors of mortality, acute respiratory distress syndrome (ARDS) was most strongly associated with mortality (aOR 22.98, 95% CI 15.28-34.55, p < 0.001), followed by need for mechanical ventilation (aOR 6.81, 95% CI 5.13-9.05, p < 0.001). Other significant risk factors included acute kidney injury (aOR 3.05, 95% CI 2.38-3.91, p < 0.001), stroke (aOR 2.40, 95% CI 1.26-4.60, p = 0.008), pulmonary embolism (OR 2.07, 95% CI 1.28-3.35, p = 0.003), and age ≥ 60 years (aOR 2.45, 95% CI 1.95-3.09, p < 0.001). Enoxaparin use was associated with lower mortality odds (aOR 0.45, 95% CI 0.35-0.60, p < 0.001. Patients hospitalized during Wave 4 (aOR 2.22, 95% CI 1.39-3.56, p < 0.001) and the post-wave 4 period (aOR 2.82, 95% CI 1.37-5.80, p = 0.005) had higher mortality odds compared to other waves. The study identifies higher mortality risk in patients admitted in Delta wave and post-wave, aged ≥ 60 years, and with respiratory and renal complications, and lower risk with anticoagulation during COVID-19 waves.
Keywords: COVID-19; Epidemic waves; Mechanical ventilation; Mortality.
. 2024 Aug 30;14(1):20205.
doi: 10.1038/s41598-024-70662-6. Risk factors for mortality in hospitalized COVID-19 patients across five waves in Pakistan
Nosheen Nasir[SUP] 1 [/SUP], Salma Tajuddin[SUP] 2 [/SUP], Afshan Akhtar[SUP] 3 [/SUP], Chanza Fahim Sheikh[SUP] 2 [/SUP], Adil Al Karim Manji[SUP] 3 [/SUP], Shameen Bhutto[SUP] 3 [/SUP], Naveera Khan[SUP] 3 [/SUP], Adnan Khan[SUP] 3 [/SUP], Muhammad Faisal Khan[SUP] 4 [/SUP], Syed Faisal Mahmood[SUP] 2 [/SUP], Bushra Jamil[SUP] 2 [/SUP], Iffat Khanum[SUP] 2 [/SUP], Kiren Habib[SUP] 2 [/SUP], Asad Latif[SUP] 4 [/SUP], Zainab Samad[SUP] 2 [/SUP], Adil H Haider[SUP] 3 [/SUP]
Affiliations
- PMID: 39215007
- PMCID: PMC11364537
- DOI: 10.1038/s41598-024-70662-6
This retrospective cohort study aims to describe the clinical characteristics and outcomes and assess risk factors for mortality across the epidemic waves in hospitalized COVID-19 patients in a major tertiary-care center in Pakistan. A total of 5368 patients with COVID-19, hospitalized between March 2020 and April 2022 were included. The median age was 58 years (IQR: 44-69), 41% were females, and the overall mortality was 12%. Comparative analysis of COVID-19 waves showed that the proportion of patients aged ≥ 60 years was highest during the post-wave 4 period (61.4%) and Wave 4 (Delta) (50%) (p < 0.001). Male predominance decreased from 65.2% in Wave 2 to 44.2% in Wave 5 (Omicron) (p < 0.001). Mortality rate was lowest at 9.4% in wave 5 and highest at 21.6% in the post-wave 4 period (p = 0.041). In multivariable analysis for risk factors of mortality, acute respiratory distress syndrome (ARDS) was most strongly associated with mortality (aOR 22.98, 95% CI 15.28-34.55, p < 0.001), followed by need for mechanical ventilation (aOR 6.81, 95% CI 5.13-9.05, p < 0.001). Other significant risk factors included acute kidney injury (aOR 3.05, 95% CI 2.38-3.91, p < 0.001), stroke (aOR 2.40, 95% CI 1.26-4.60, p = 0.008), pulmonary embolism (OR 2.07, 95% CI 1.28-3.35, p = 0.003), and age ≥ 60 years (aOR 2.45, 95% CI 1.95-3.09, p < 0.001). Enoxaparin use was associated with lower mortality odds (aOR 0.45, 95% CI 0.35-0.60, p < 0.001. Patients hospitalized during Wave 4 (aOR 2.22, 95% CI 1.39-3.56, p < 0.001) and the post-wave 4 period (aOR 2.82, 95% CI 1.37-5.80, p = 0.005) had higher mortality odds compared to other waves. The study identifies higher mortality risk in patients admitted in Delta wave and post-wave, aged ≥ 60 years, and with respiratory and renal complications, and lower risk with anticoagulation during COVID-19 waves.
Keywords: COVID-19; Epidemic waves; Mechanical ventilation; Mortality.