Features and Outcome of Patients with Severe and Critical Covid-19: A Retrospective Cross-Sectional Analytical Study

Abstract

Background: Clinical spectrum of COVID-19 disease passes from symptom free or with mild upper respiratory symptoms to the acute respiratory distress syndrome (ARDS). The virus may affect different organs. Risk factors to progression to the severe forms of the diseases have been described as an urgent research priority. The case mix and outcome of these patients have not been analyzed and published to guide the scientific community on this new pandemic. Data are badly lacking from Low Income Countries, in general and in Rwanda, in particular. Aim: The aim was to determine the main clinical features and outcome of severe and critical COVID-19 patients during the third wave of the pandemic at the University Teaching Hospital of Butare (CHUB), Rwanda. Methods: This was a retrospective study design. Subjects were patients with confirmed SARSCoV-2 by PCR and/or Ag RDT, hospitalized for care in ICU/HDU for COVID-19 at CHUB from May to October 2021. Data including demographic characteristics, clinical symptoms, vaccination status, comorbidity, inflammatory markers, therapeutic support modalities and other specific treatment for COVID-19, antibiotherapy, discharge status and hospital length of stay were collected from the patients’ medical records. Categorical data were presented in terms of frequency and percentage while continuous data were presented as median (IQR)). Logistic regression (binary and multivariate logistic regression analysis) were used to study the relationship between the outcome (mortality) and possible predictors. A p<0.05 was considered as statistically significant. Results: 98 patients were taken on in this study and median (IQR) of their age was 63.5(51-75). The median (IQR) of LOS in days was 6(3-10) and the most frequent comorbidity was hypertension present in 24.5% of cases. 72.45% presented with cough, 66% presented with shortness of breath and 31.6% with chest pain, eighteen patients (18.37%) presented with decreased level of consciousness. The most common complications were respiratory failure at rate of 64.3% including ARDS cases (21.4%), Acute Kidney Injury (AKI) at rate of 19.4% and septic shock at rate of 9.1%. More than a half (61.2%) of patients admitted with severe or/ and critical COVID-19 disease died and almost all deaths were COVID-19-related. The multivariable logistic regression showed that increased urea and UVA score at admission were independent factors for in-hospital mortality. Conclusion: There was a high mortality for severe and critical COVID-19 patients admitted at CHUB. This mortality could have been predicted by high urea (AKI) and UVA score.