Characterization and determinant factors of critical illness and in-hospital mortality of COVID-19 patients: A retrospective cohort of 1,792 patients in Kenya

Abstract

Limited data is available on the coronavirus disease 2019 (COVID-19), critical illness rate, and in-hospital mortality in the African setting. This study investigates determinants of critical illness and in-hospital mortality among COVID-19 patients in Kenya. We conducted a retrospective cohort study at Kenyatta National Hospital (KNH) in Kenya. Multivariate logistic regression and Cox proportional hazard regression were employed to determine predictor factors for intensive care unit (ICU) admission and in-hospital mortality, respectively. In addition, the Kaplan-Meier model was used to compare the survival times using log-rank tests. As a result, 346 (19.3%) COVID-19 patients were admitted to ICU, and 271 (15.1%) died. The majority of those admitted to the hospital were male, 1,137 (63.4%) and asymptomatic, 1,357 (75.7%). The most prevalent clinical features were shortness of breath, fever, and dry cough. In addition, older age, male, health status, patient on oxygen (O2), oxygen saturation levels (SPO2), headache, dry cough, comorbidities, obesity, cardiovascular diseases (CVDs), diabetes, chronic lung disease (CLD), and malignancy/cancer can predicate the risk of ICU admission, with an area under the receiver operating characteristic curve (AUC-ROC) of 0.90 (95% confidence interval [CI]: 0.88–0.92). Survival analysis indicated 271 (15.1%) patients died and identified older age, male, headache, shortness of breath, health status, patient on oxygen, SPO2, headache, comorbidity, CVDs, diabetes, CLD, malignancy/cancer, and smoking as risk factors for mortality (AUC-ROC: 0.90, 95% CI: 0.89–0.91). This is the first attempt to explore predictors for ICU admission and hospital mortality among COVID-19 patients in Kenya.

Keywords

• Comorbidities
• Critical illness
• ICU
• COVID-19
• SARS-CoV-2