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Predictors of Mortality in COVID-19 Patients at Kinshasa Medical Center and A Survival Analysis: A Retrospective Cohort Study

Article scientifique 2021 Anglais

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Abstract BackgroundDespite it being a global pandemic, there is little research examining the clinical features of severe COVID-19 in sub-Saharan Africa. This study aims to identify predictors of mortality in COVID-19 patients in an African setting.MethodsIn this retrospective, observational, cohort study carried out at the Kinshasa Medical Centre (KMC) between March 10, 2020 and July 10, 2020, we included all adult inpatients (≥18 years old) with a laboratory diagnosis by PCR of COVID-19. The end point of the study was survival to discharge (time-to-death).The study population was dichotomized into survivors and non-survivors group. Kaplan-Meier plot was used for survival analyses. The Log-Rank test was employed to compare the survival curves. Predictors of mortality were identified by Cox regression models. The significance level of P value was set at 0.05.Results106 patients (mean age 55.6±13.2 years old, 80.2% were male), were included in this study, of whom 34 (32 %) died during their hospitalisation. The main Complications of the patients included ARDS in 59/66 (89.4%) patients, coagulopathy in 35/93 (37.6%) patients, acute cardiac injury in 24/98 (24.5%) patients, AKI in 15/74 (20.3%) patients and secondary infection in 12/81 (14.8%) patients. The independent predictors of mortality were found to be age ≥ 65 years [aHR 2.49; 95% CI: 1.53-5.69], AKI stage 3 [aHR 2.51; 95% CI: 1.33-6.80], proteinuria [aHR 2.60; 95% CI: 1.40-6.42], CRP >150 mg/L [aHR 2.75; 95% CI: 1.29-3.68] and procalcitonin (PCT) > 0.5 ng/ml [aHR 3.20; 95% CI: 1.70-7.49].The median survival time of the entire group was 12 days. The cumulative survival rate of COVID-19 patients was 86.9%, 65.0% and 19.9% respectively at 5, 10 and 20 days. Levels of creatinine (p= 0.012), were clearly elevated in non-survivors compared with survivors throughout the clinical course and increased deterioration.ConclusionThe results from this study demonstrated that an advanced age, proteinuria, AKI and raised CRP and PCT offered a worse prognosis in COVID-19 patients. In addition, serum levels of creatinine significantly rose during admission in the non-survivor group compared with those who survived to discharge.

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Nlandu, Y., Mafuta, D., Sakaji, J., Brecknell, M., Engole, Y., Abatha, J., Nkumu, J., Nkodila, A., Mboliassa, M., Tuyinama, O., Bena, D., Mboloko, Y., Kobo, P., Boloko, P., Tshangu, J., Azika, P., Kanku, J., Mafuta, P., Atantama, M., Mavungu, J., Kitenge, R., Sehli, A., Eckout, K., Mukuku, C., Bergeret, L., Benchetritt, D., Kalifa, G., Ahmed, R., Bukabau, J. (2021). Predictors of Mortality in COVID-19 Patients at Kinshasa Medical Center and A Survival Analysis: A Retrospective Cohort Study. https://doi.org/10.21203/rs.3.rs-153818/v1

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Auteur(s)

Yannick Mayamba Nlandu Danny Mafuta Junior Sakaji Melinda Brecknell Yannick Mompango Engole Jessy Abatha Jean-Robert Nkumu Aliocha Natuhoyila Nkodila Marie-France Mboliassa Olivier Tuyinama Dauphin Bena Yves Mboloko Patrick Kobo Patrick Boloko Joseph Tshangu Philippe Azika Jean-Pierre Kanku Pally Mafuta Magloire Atantama Jean-Michel Mbuku Mavungu Rosita Kitenge Asma Sehli Karel Van Eckout Cathy Mukuku Léo Bergeret David Benchetritt G Kalifa Rodolphe Ahmed Justine Busanga Bukabau

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