Factors associated with mortality among severely ill covid-19 patients, Nairobi metropolis, Kenya

Abstract

Background: Severe Coronavirus Disease 2019 (COVID-19) occurs in about 20% of hospitalized patients. Many of these patients have comorbidities and are the main contributors for COVID-19 mortality. The most common underlying conditions include hypertension, diabetes, and chronic lung disease. Objectives: To describe socio-demographic factors of severe COVID-19 patients; determine the clinical, laboratory, and radiological characteristics and outcomes of severe COVID-19 disease; and evaluate the predictors of mortality for severely ill COVID-19 patients. Methods: A cross-sectional study in Nairobi Metropolis was conducted between September and December 2021. Patient information was collected from the inpatient registers of selected hospitals with COVID-19 isolation centers. This included demographic and clinical information, presenting signs and symptoms, laboratory and radiological findings during hospitalization, and case management. A severe COVID- 19 patient was defined as any COVID-19 patient with any of the following: oxygen saturation <94% in room air, respiratory rate >30 breaths/minute, and any signs of respiratory distress such as difficulty in breathing, or rapid breathing, confusion, reduced blood pressure, low blood oxygen, and tiredness. Mortality (case) was defined as any patient with severe COVID-19 infection who died, as recorded and reported by the hospital. Non-case was defined as any patient who survived a severe COVID-19 infection. Means and medians were calculated for continuous variables, and frequencies and proportions for categorical variables. Chi-square and multivariable binary logistic regression compared exposure factors with disease outcome. The study proposal was approved by Moi University Institutional Research Ethics Committee (IREC). Results: Total abstracted records were for 818 patients; 500 (61%) severe patients (153 non-survivors, 347 survivors). The analysis involved 150 non-survivors and 150 survivors. Males were 66.8%, and a mean age of 53.29 years ± 17.7. Sixty-four (64.3) percent presented with difficulty breathing, cough 63.7%, while 33.3% had a fever. Patients with Peripheral Oxygen Saturation (SPO2) of ≤94% were 39.9% at admission, rising to 90.0% during isolation. Patients with underlying diabetes were 29.3%, while hypertension/heart disease was 28.3%. Patients that developed acute respiratory distress syndrome (ARDS) were 26.0%. Patients put on oxygen therapy were 28.3%, mechanical ventilation 19.3%, and ICU admissions were 3.7%. Factors significantly associated with death were: hypertension (OR-3.5, 95% CI- 1.34–9.45, p-value- 0.011); ARDS (OR- 8.9, 95% CI- 3.05–26.14, p-value- <0.001); severe disease at admission (OR- 18.7, 95% CI- 5.24–67.15, p-value <0.001); and failure to receive oxygen treatment (OR- 17.5, 95% CI- 5.54–55.32, p-value <0.001). Conclusion: The results highlighted that advanced age, hypertension, hypoxia at admission, and lack of oxygen therapy were independently associated with increased risk of death. These findings are consistent with international evidence, yet they also reflect unique health system challenges within the Kenyan context. Recommendation: We recommend that the government of Kenya, through the Ministry of Health, should: enhance early risk stratification and triage, scale up oxygen supply and infrastructure, expand intensive care capacity, and improve management of non-communicable diseases, among others.