Article Figures & Data
Figures
- Figure 1
- Case fatality rate (CFR) of coronavirus disease- 2019 stratified by month and the average intensive care unit (ICU) bed occupancy rate, for the highest 6 cities in Kingdom of Saudi Arabia between April and July 2020. A) Riyadh, B) Khamis Mushait, C) Taif, D) Al-Kharj, E) Jeddah, and F) Tabuk.
- Figure 2
- Kaplan-Meier analysis of survival (time-to-death) of coronavirus disease- 2019 (COVID-19) mortality cases. A) Analysis of survival of all COVID-19 mortality cases. B) Coronavirus disease- 2019 mortality cases stratified by (direct - indirect) as a cause of death. C) Coronavirus disease- 2019 mortality cases stratified by intensive care unit (ICU)/general ward admission. D) Coronavirus disease- 2019 mortality cases stratified by (do-not-resuscitate [DNR] - Full Code).
Tables
- Table 1
- Baseline characteristics of coronavirus disease 2019 (COVID-19) mortality cases admitted to Armed Forces Medical Services (MSD) hospitals, Kingdom of Saudi Arabia, between March and July 2020 (N=224).
Baseline characteristics n (%) Age (years), mean±SD 69.66±14.68 Gender Male 142 (63.4) Female 82 (36.6) Nationality Saudi 208 (92.9) Non-Saudi 16 (7.1) Hospital location Riyadh 115 (51.3) Al-Kharj 32 (14.3) Taif 18 (8.0) Jeddah 14 (6.3) Tabuk 11 (4.9) Madina Al Munnawarah 7 (3.1) Dhahran 7 (3.1) Khamis Mushait 7 (3.1) Wadi Al Dawasir 5 (2.2) Hafr Al Batin 3 (1.3) Najran 2 (0.9) Jizan 2 (0.9) Jubail 1 (0.4) Source of hospital admission Emergency room 198 (88.4) Intra-hospital transfer (from within) 8 (3.6) Transfer from another hospital 7 (3.1) Unknown 11 (4.9) Smoker Yes 12 (5.4) No 207 (92.4) Not documented 5 (2.2) Blood type B 109 (48.7) O 68 (30.4) A 35 (15.6) AB 12 (5.4) Rh factors Positive 215 (96.0) Negative 9 (4.0) Cause of death from COVID-19 Direct 164 (73.2) Indirect 60 (26.8) Length of hospital stay (days), median (minimum - maximum) 10 (0-90) Total 224 (100) Rh: rhesus factor, SD: standard deviation
- Table 2
- Clinical and epidemiological characteristics of COVID-19 mortality cases admitted to MSD hospitals, Kingdom of Saudi Arabia, between March and July 2020, stratified by cause of death from COVID-19 (N=224).
Clinical characteristics Direct (n=164) Indirect (n=60) n (%) Total (N=224) P-value* Age, mean±SD 70.32±14.17 67.87±16.00 69.66±14.68 0.365‡ DNR 75 (45.7) 33 (55.0) 108 (48.2) 0.219 Full code 89 (54.3) 27 (45.0) 116 (51.8) Resuscitated 84 (51.2) 25 (41.7) 109 (48.7) 0.205 Intubated 114 (69.5) 42 (70.0) 156 (69.6) 0.944 Any symptoms§ 158 (97.5) 52 (86.7) 210 (94.6) 0.001†† Symptoms** Shortness of breath 125 (76.2) 40 (66.7) 165 (73.7) 0.151 Fever 120 (73.2) 34 (56.7) 154 (68.8) 0.018†† Cough 113 (68.9) 32 (53.3) 145 (64.7) 0.031†† Confusion 21 (12.8) 11 (18.3) 32 (14.3) 0.295 Diarrhea 9 (5.5) 8 (13.2) 17 (7.6) 0.050 Chest pain 11 (6.7) 1 (1.7) 12 (5.4) 0.138 Desaturation (SpO2<94%)** 87 (53.0) 26 (43.3) 113 (50.4) 0.198 PPD/QuantiFERON test Positive 16 (10.7) 11 (19.6) 27 (13.2) 0.201 Negative 133 (89.3) 45 (80.4) 178 (86.8) Total 149 (100.0) 56 (100.0) 205 (100.0) Chest X-ray§,** Normal 12 (3.4) 6 (4.5) 18 (3.7) 0.957 Bilateral infiltration 114 (32.5) 42 (31.6) 156 (32.2) Infiltrate/opacities 122 (34.8) 47 (35.3) 169 (34.9) Pleural effusion 103 (29.3) 38 (28.6) 141 (29.2) Total 351 (100.0) 133 (100.0) 484 (100.0) Transfusion history 37 (22.6) 29 (48.3) 66 (29.5) <0.001†† Type of transfusion history§ PRBCs 32 (45.1) 25 (45.5) 57 (45.2) 0.793 FFP 15 (21.1) 15 (27.3) 30 (23.8) Cryoprecipitate 8 (11.3) 3 (5.5) 11 (8.7) Platelets 10 (14.1) 8 (14.5) 18(14.3) Intravenous immunoglobulin 6 (8.5) 4 (7.3) 10 (7.9) Total 71 (100.0) 55 (100.0) 126 (100.0) Was death anticipated? 146 (89.0) 47 (78.3) 193 (86.2) 0.040†† COVID-19 PCR at time of death Positive 138 (89.6) 41 (77.4) 179 (86.5) 0.032†† Negative 16 (10.4) 12 (22.6) 28 (13.5) Total 179 (100.0) 28 (100.0) 207 (100.0) Co-morbidities Diabetes 122 (74.4) 43 (71.7) 165 (73.7) 0.682 Hypertension 117 (71.3) 39 (65.0) 156 (69.6) 0.361 Chronic kidney failure 40 (24.4) 16 (26.7) 56 (25.0) 0.728 Coronary artery disease 39 (23.8) 13 (21.7) 52 (23.2) 0.740 Heart failure 16 (9.8) 9 (15.0) 25 (11.2) 0.270 Asthma 19 (11.6) 5 (8.3) 24 (10.7) 0.486 Multiple sclerosis 19 (11.6) 4 (6.7) 23 (10.3) 0.283 Atrial fibrillation 14 (8.5) 8 (13.3) 22 (9.8) 0.285 On dialysis 14 (8.5) 3 (5.0) 17 (7.6) 0.376 Ischemic stroke 13 (7.9) 3 (5.0) 16 (7.1) 0.451 Thyroid dysfunction 11 (6.7) 5 (8.3) 16 (7.1) 0.676 Dementia 4 (2.4) 8 (13.3) 12 (5.4) 0.001†† COPD 6 (3.7) 1 (1.7) 7 (3.1) 0.448 Obesity 3 (1.8) 2 (3.3) 5 (2.2) 0.500 Co-infection Positive 37 (23.1) 27 (46.6) 64 (29.4) <0.001†† Negative 123 (76.9) 31 (53.4) 154 (70.6) Total 160 (100.0) 58 (100.0) 218 (100.0) If co-infection positive§ Bacterial 19 (47.5) 17 (65.4) 36 (54.5) 0.186 Fungal 4 (10.0) 3 (11.5) 7 (10.6) Viral 17 (42.5) 6 (23.1) 23 (34.8) Total 40 (100.0) 26 (100.0) 66 (100.0) Complications§ ARDS 116 (75.8) 24 (64.2) 150 (72.8) 0.100 Shock 61 (39.9) 32 (60.4) 93 (45.1) 0.010†† Acute kidney injury 67 (43.8) 23 (43.4) 90 (43.7) 0.960 Sepsis/septic shock 54 (35.3) 24 (45.3) 78 (37.9) 0.196 Secondary infections 20 (13.1) 9 (17.0) 29 (14.1) 0.481 Cardiogenic shock 6 (3.9) 8 (15.1) 14 (6.8) 0.005†† Heart failure 7 (4.6) 6 (11.3) 13 (6.3) 0.082 Acute cardiac injury 11 (7.2) 1 (1.9) 12 (5.8) 0.155 Total 153 (100.0) 53 (100.0) 206 (100.0) COVID-19: coronavirus disease-19, MSD: Armed Forces Medial Services, DNR: do-not-resuscitate, PPD/QuantiFERON: Purified protein derivative/QuantiFERON, PRBCs: packed red blood cells, FFP: fresh frozen plasma, PCR: polymerase chain reaction, COPD: chronic obstructive pulmonary disease, ARDS: acute respiratory distress syndrome. *Chi-square test, ‡T-test. §Reported one or more co-infection, chest X-ray, type of transfusion history and complications, **at day of presentation. ††p<0.05 was considered significant
- Table 3
- Biomarker trends of Coronavirus disease-19 mortality cases (at day of presentation, day 3-4, and 24-hours prior to death) admitted to PSMMC hospital between March and July 2020 (N=115).
Trends biomarker Median (minimum - maximum) P-value* Day of presentation Day (3-4)‡ 24-hours prior to death‡ Lymphocytes (× 109/L) 0.9 (0.0-5.3) 0.8 (0.0-10.5) 0.9 (0.0-7.9) 0.182 Serum ferritin (pmol/L) 686 (37-9164) 832 (54-19864) 1081 (15-30356) 0.004† D-dimer (mcg/mL) 1.53 (0.18-20.0) 1.83 (0.30-20.0) 3.81 (0.11-20.0) <0.001† Serum creatinine (mol/L) 104 (18-1220) 117 (15-978) 172 (19-1627) 0.059 C-reactive protein (mg/l) 90 (1-359) 76 (2-429) 99 (5-385) 0.478 Procalcitonin (mcg/l) 0.4 (0.05-59.0) 0.05 (0.05-57.0) 1.2 (0.03-99.3) 0.004† PSSMC: Prince Sultan Military Medical City, *Wilcoxon signed ranks test. †p<0.05 was significant. ‡The day 3-4 and 24-hours prior to death comparison had some missing values due to a number of the patients dying before they reached this stage.
- Table 4
- Logistic regression for risk factors in direct mortality cases and cases admitted to ICUs with COVID-19 (N=224).
Variable Direct death ICU admission OR (95% CI) P-value OR (95% CI) P-value Age 0.98 (0.97-1.00) 0.270 1.01 (0.99-1.03) 0.270 Gender: male 0.91 (0.49-1.68) 0.763 1.92 (1.09-3.37) 0.022† Resuscitated 1.47 (0.80-2.67) 0.206 0.99 (0.57-1.71) 0.978 Death was anticipated 2.24 (1.02-4.92) 0.044† 3.26 (1.493-7.14) 0.003† Desaturation (SpO2 <94%)* 1.47 (0.81-2.68) 0.199 1.77 (1.02-3.06) 0.042 Co-infection 0.34 (0.18-0.651) 0.001† 2.94 (1.47-5.85) 0.002† Comorbidities: COPD 2.24 (0.26-19.00) 0.460 0.42 (0.09-1.92) 0.265 Complications ARDS 1.75 (0.89-3.43) 0.102 2.02 (1.07-3.80) 0.029† Acute kidney injury 1.01 (0.54-1.90) 0.960 1.87 (1.03-3.40) 0.039† Shock 0.43 (0.23-0.82) 0.011† 2.72 (1.47-5.01) 0.001† Sepsis/septic 0.65 (0.34-1.24) 0.198 2.92 (1.52-5.60) 0.001† Secondary infections 0.73 (0.31-1.73) 0.482 2.85 (1.03-7.84) 0.042† Cardiogenic shock 0.23 (0.07-0.69) 0.009† 3.36 (0.73-15-.47) 0.119 ICUs: intensive care units, COVID-19: coronavirus disease -19, COPD: chronic obstructive pulmonary disease, ARDS: acute respiratory distress syndrome, OR: odds ratio, CI: confidence interval
