Mortality predictors of hospitalized patients with COVID-19: Retrospective cohort study from Nur-Sultan, Kazakhstan

First reported case of Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) in Kazakhstan was identified in March 2020. Many specialized tertiary hospitals in Kazakhstan including National Research Cardiac Surgery Center (NRCSC) were re-organized to accept coronavirus disease 2019 (C...

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Published in:	PloS one Vol. 16; no. 12; p. e0261272
Main Authors:	Pya, Yuriy, Bekbossynova, Makhabbat, Gaipov, Abduzhappar, Lesbekov, Timur, Kapyshev, Timur, Kuanyshbek, Aidyn, Tauekelova, Ainur, Litvinova, Liya, Sailybayeva, Aliya, Vakhrushev, Ivan, Sarria-Santamera, Antonio
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 22-12-2021 Public Library of Science (PLoS)
Subjects:	Adult Age Age Factors Aged Anemia Anesthesiology Biology and Life Sciences Biomarkers Body temperature C-reactive protein Cardiology Care and treatment Coagulation Cohort analysis Cohort Studies Coronaviruses COVID-19 COVID-19 - epidemiology COVID-19 - mortality Data collection Dehydrogenases Dimers Fatalities Female Ferritin Fever Fibrinogen Health risks Heart rate Heart surgery Hospital Mortality - trends Hospital patients Hospitalization - statistics & numerical data Hospitalization - trends Hospitals Humans Infectious diseases Inflammation Intensive care Kazakhstan - epidemiology Kidneys L-Lactate dehydrogenase Laboratories Lactate dehydrogenase Lactic acid Leukocytosis Lymphopenia Male Medical research Medicine Medicine and Health Sciences Middle Aged Mortality Mortality risk Oxygen Oxygen content Pandemics Patient outcomes Patients People and Places Personal information Physical Sciences Pneumonia Polymerase chain reaction Prognosis Proteins Regression analysis Regression models Respiration Respiratory diseases Respiratory Rate Retrospective Studies Risk analysis Risk Factors SARS-CoV-2 - pathogenicity Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Tertiary Thromboplastin Tomography Viral diseases Kazakhstan
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Summary:	First reported case of Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) in Kazakhstan was identified in March 2020. Many specialized tertiary hospitals in Kazakhstan including National Research Cardiac Surgery Center (NRCSC) were re-organized to accept coronavirus disease 2019 (COVID-19) infected patients during summer months of 2020. Although many studies from worldwide reported their experience in treating patients with COVID-19, there are limited data available from the Central Asia countries. The aim of this study is to identify predictors of mortality associated with COVID-19 in NRCSC tertiary hospital in Nur-Sultan, Kazakhstan. This is a retrospective cohort study of patients admitted to the NRCSC between June 1st-August 31st 2020 with COVID-19. Demographic, clinical and laboratory data were collected from electronic records. In-hospital mortality was assessed as an outcome. Patients were followed-up until in-hospital death or discharge from the hospital. Descriptive statistics and factors associated with mortality were assessed using univariate and multivariate logistic regression models. Two hundred thirty-nine admissions were recorded during the follow-up period. Mean age was 57 years and 61% were males. Median duration of stay at the hospital was 8 days and 34 (14%) patients died during the hospitalization. Non-survivors were more likely to be admitted later from the disease onset, with higher fever, lower oxygen saturation and increased respiratory rate compared to survivors. Leukocytosis, lymphopenia, anemia, elevated liver and kidney function tests, hypoproteinemia, elevated inflammatory markers (C-reactive protein (CRP), ferritin, and lactate dehydrogenase (LDH)) and coagulation tests (fibrinogen, D-dimer, international normalized ratio (INR), and activated partial thromboplastin time (aPTT)) at admission were associated with mortality. Age (OR 1.2, CI:1.01-1.43), respiratory rate (OR 1.38, CI: 1.07-1.77), and CRP (OR 1.39, CI: 1.04-1.87) were determined to be independent predictors of mortality. This study describes 14% mortality rate from COVID-19 in the tertiary hospital. Many abnormal clinical and laboratory variables at admission were associated with poor outcome. Age, respiratory rate and CRP were found to be independent predictors of mortality. Our finding would help healthcare providers to predict the risk factors associated with high risk of mortality. Further investigations involving large cohorts should be provided to support our findings.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0261272