Clinical profile and Predictors of Outcomes of Hospitalized Patients with Laboratory-Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 in Nigeria: A Retrospective Analysis of 13 High Burden States in Nigeria
Christopher Sabo Yilgwan, Adamu Onu, Joshua Ofoli, Longji Benle Dakum, Shehu Nathan Yakubu, Dimie Ogoina, Ijeoma Okoli, Deborah Osisanwo, Vivian Okafor, Adebola Olayinka, Ibrahim Mamadu, Adebimpe Adebiyi
Background: The majority of global COVID deaths have occurred in developed countries. Not much is known about the clinical outcomes for the patients admitted with COVID in Nigeria. We thus described the clinical characteristics, outcomes, and predictors of outcomes of hospitalized Nigerian COVID-19 patients. Methodology: We performed multilevel and mixed effects regression, Kaplan-Meir survival, and Cox proportionate hazards analyses to evaluate factors associated with death in patients admitted for COVID-19 in 13 high-burden states of Nigeria between 25 th February 2020 and 30 th August 2021. Results: Of the 3462 patients (median age, 40 years (interquartile range 28 years 54 years), 2,990(60.6%) were male and, 213(6.15%) of them died while on admission. Male sex (adjusted odds ratio [aOR], 1.78 [95% confidence interval {CI}, 1.23-2.56]), age group 45-65 years (OR, 3.93 [95% CI, 1.29-12.02]), age group 66-75 years (aOR, 5.37 [95% CI,), age group > 75 years (aOR, 6.81 [95% CI, 2.04-22.82]), chronic cardiac disease (aOR, 3.07 [95% CI, 1.20-7.86]), being diabetic (aOR, 2.16 [95% CI, 1.41-3.31]), and having chronic kidney disease (OR, 11.01 [95% CI,),were strongly associated with increased odds of death. Having concurrent malaria (aOR, 0.45 [95% CI, 0.16-1.28]), use of Azithromycin for treatment (aOR, 0.33 [95% CI, 0.19-0.54]), and use of Chloroquine/Hydroxychloroquine for treatment (aOR, 0.07 [95% CI, 0.03-0.14]) were significantly associated with decreased odds of death. Conclusions: The cumulative probability of death of male patients, diabetics, hypertensives, and patients with CKD was higher than that of female patients and those without those comorbidities while concurrent malaria and use of chloroquine/hydroxychloroquine in the treatment regimen were associated with a decreased risk of dying in patients treated in our isolation centers.
Conflict of interest: None declared.
Contributors Statement Dr Yilgwan CS, Shehu NY, Okoli I and Dakum L conceptualized and designed the study, analyzed the data, drafted the initial manuscript, and reviewed and revised the manuscript. Onu A designed the data collection instruments, collected data and reviewed and revised the manuscript. Dakum LB, Ogoina D and Adebiyi A supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Conclusions In this study, we found that male sex, older age of the patient, the presence of comorbidities like diabetes, and chronic heart, and kidney diseases on admission were associated with increased risk of mortality due to COVID-19 infection while concurrent malaria infection and use of chloroquine/hydroxychloroquine and azithromycin were associated with a decreased risk of mortality in patients treated in our isolation centers. This information is significant in that it updates our understanding as well as provides guidance to physicians managing patients with COVID-19 and may help to improve care for patients through risk stratification. It also helps our health policymakers in reaching public health decisions on the allocation of healthcare resources and personnel in this current and future pandemic.
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