Thirty-Day Outcomes of Young and Middle-Aged Adults Admitted with Severe COVID-19 in Uganda: A Retrospective Cohort Study
Tonny Kyagambiddwa, Timothy Mwanje Kintu, Emmanuel Miiro, Franchesca Nabalamba, Gloria Suubi Asiimwe, Anne Marion Namutebi, Fardous C Abeya, Boniface A Lumori, Isaac Ijuka, Rose K Muhindo, Andrew Mutekanga, Richard Musinguzi, Francis Natuhwera, Joseph Ngonzi, Edwin Nuwagira
Infection and Drug Resistance, doi:10.2147/idr.s405256
Background: There is scarcity of data regarding young and middle-aged adults hospitalized with severe Corona Virus Disease 2019 (COVID-19) in Africa. In this study, we describe the clinical characteristics and 30-day survival among adults aged 18 to 49 years admitted with severe COVID-19 in Uganda. Methods: We reviewed treatment records of patients admitted with severe COVID-19 across five COVID-19 treatment units (CTU) in Uganda. We included individuals aged 18 to 49 years, who had a positive test or met the clinical criteria for COVID-19. We defined severe COVID-19 as having an oxygen saturation <94%, lung infiltrates >50% on imaging and presence of a co-morbidity that required admission in the CTU. Our main outcome was the 30-day survival from the time of admission. We used a Cox proportional hazards model to determine the factors associated with 30-day survival at a 5% level of significance. Results: Of the 246 patient files reviewed, 50.8% (n = 125) were male, the mean ± (standard deviation) age was 39 ± 8 years, majority presented with cough, 85.8% (n = 211) and median C-reactive protein (interquartile range) was 48 (47.5, 178.8) mg/L. The 30-day mortality was 23.9% (59/246). At admission, anemia (hazard ratio (HR): 3.00, 95% confidence interval (CI), 1.32-6.82; p = 0.009) and altered mental state (GCS <15) (HR: 6.89, 95% CI: 1.48-32.08, p = 0.014) were significant predictors of 30-day mortality. Conclusion: There was a high 30-day mortality among young and middle-aged adults with severe COVID-19 in Uganda. Early recognition and targeted management of anemia and altered consciousness are needed to improve clinical outcomes.
Abbreviations
Ethics Approval and Informed Consent The study was approved by the Research Ethics Committee of Mbarara University of Science and Technology under reference number MUST-2022-435. The ethics committee waived the requirement for consent. Permission for access to medical records was granted by the necessary boards at respective hospitals. Study codes were used to ensure the anonymity of participants' data. Data generated from the study shall be used for research purposes only and shall be private and confidential at all times. All principles of data transfer and principles of protection of human research participants outlined in the Declaration of Helsinki were observed.
Disclosure The authors declare that they have no competing interests.
References
Adebisi, Rabe, Lucero-Prisno, De, COVID-19 surveillance systems in 13 African countries, Health Promot Perspect,
doi:10.34172/hpp.2021.49
Anjorin, Abioye, Asowata, Comorbidities and the COVID-19 pandemic dynamics in Africa, Trop Med Int Health TM IH,
doi:10.1111/tmi.13504
Apiyo, Olum, Kabuye, Clinical characteristics and outcomes of patients hospitalized with COVID-19 at case hospital, Uganda, Interdiscip Perspect Infect Dis,
doi:10.1155/2022/5477790
Baguma, Okot, Alema, Factors associated with mortality among the COVID-19 patients treated at Gulu Regional referral hospital: a retrospective study, Front Public Health,
doi:10.3389/fpubh.2022.841906
Bergamaschi, Borrelli De Andreis, Aronico, Anemia in patients with Covid-19: pathogenesis and clinical significance, Clin Exp Med,
doi:10.1007/s10238-020-00679-4
Bongomin, Fleischer, Olum, High mortality during the second wave of the coronavirus disease 2019 (COVID-19) pandemic in Uganda: experience from a National Referral COVID-19 treatment unit, Open Forum Infect Dis,
doi:10.1093/ofid/ofab530
Chen, Hoiland, Stukas, Wellington, Sekhon, Confronting the controversy: interleukin-6 and the COVID-19 cytokine storm syndrome, Eur Respir J,
doi:10.1183/13993003.03006-2020
Chinnaswamy, Understanding the devastating second wave of COVID -19 pandemic in India, Am J Hum Biol,
doi:10.1002/ajhb.23671
Core, R: a language and environment for statistical computing
Dadras, Seyedalinaghi, Karimi, COVID-19 mortality and its predictors in the elderly: a systematic review, Health Sci Rep,
doi:10.1002/hsr2.657
English, Cn, Uganda lacks medical oxygen as hospitals overwhelmed by COVID-19, Xinhua
Gupta, Garg, Sapra, Infection and Drug Resistance Dovepress
Herrera-Esposito, De, Campos, Age-specific rate of severe and critical SARS-CoV-2 infections estimated with multi-country seroprevalence studies, BMC Infect Dis,
doi:10.1186/s12879-022-07262-0
Jha, Tak, Gupta, Relationship of anemia with COVID-19 deaths: a retrospective cross-sectional study, J Anaesthesiol Clin Pharmacol,
doi:10.4103/joacp.joacp_63_22
Kirenga, Muttamba, Kayongo, Characteristics and outcomes of admitted patients infected with SARS-CoV-2 in Uganda, BMJ Open Respir Res,
doi:10.1136/bmjresp-2020-000646
Migisha, Kwesiga, Mirembe, Early cases of SARS-CoV-2 infection in Uganda: epidemiology and lessons learned from risk-based testing approaches -march, Glob Health,
doi:10.1186/s12992-020-00643-7
Mvb| Nw| Cn|, Obesity studies highlight severe COVID outcomes, even in young adults, CIDRAP
Mwananyanda, Gill, Macleod, Covid-19 deaths in Africa: prospective systematic postmortem surveillance study, BMJ,
doi:10.1136/bmj.n334
News-Medical, Individuals under 65 years may be the predominant drivers of COVID-19 in West Africa
Oh, Skendelas, Macdonald, On-admission anemia predicts mortality in COVID-19 patients: a single center, retrospective cohort study, Am J Emerg Med,
doi:10.1016/j.ajem.2021.03.083
Perazzo, Cardoso, Ribeiro, In-hospital mortality and severe outcomes after hospital discharge due to COVID-19: a prospective multicenter study from Brazil, Lancet Reg Health Am,
doi:10.1016/j.lana.2022.100244
Springerlink, Disorders of consciousness in hospitalized patients with covid-19: the role of the systemic inflammatory response syndrome,
doi:10.1007/s12028-021-01256-7
Starke, Reissig, Petereit-Haack, Schmauder, Nienhaus et al., The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis, BMJ Glob Health,
doi:10.1136/bmjgh-2021-006434
Statsenko, Zahmi, Habuza, Impact of age and sex on COVID-19 severity assessed from radiologic and clinical findings, Front Cell Infect Microbiol,
doi:10.3389/fcimb.2021.777070
Tabernero, Ruiz, España, COVID-19 in young and middle-aged adults: predictors of poor outcome and clinical differences, Infection,
doi:10.1007/s15010-021-01684-9
Tao, Xu, Chen, Anemia is associated with severe illness in COVID-19: a retrospective cohort study, J Med Virol,
doi:10.1002/jmv.26444
Team, Uganda, one ICU Bed for 188,000 Ugandans. The Monitor; 2021
Van Son, Oussaada, Şekercan, Overweight and obesity are associated with acute kidney injury and acute respiratory distress syndrome, but not with increased mortality in hospitalized COVID-19 patients: a retrospective cohort study, Front Endocrinol,
doi:10.3389/fendo.2021.747732
Wu, Mcgoogan, 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,
doi:10.1001/jama.2020.2648
Xiong, Lu, Zhang, Association of consciousness impairment and mortality in people with COVID-19, Acta Neurol Scand,
doi:10.1111/ane.13471
Zhang, Wu, He, Age-related risk factors and complications of patients with COVID-19: a population-based retrospective study, Front Med,
doi:10.3389/fmed.2021.757459