Survival, mortality, and related comorbidities among COVID-19 patients in Saudi Arabia: A hospital-based retrospective cohort study

Mohammad A. AL-Ghamdi; Rajaa M. Al-Raddadi; Iman K. Ramadan; Ahmad A. Mirza; Hanan A. Alsaab; Hani F. Alobaidi; Mohammed Y. Bin Hayd

doi:10.15537/smj.2022.43.8.20220182

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Figure 1
- Kaplan-Meier survival curve of significant predictors of mortality: A) age wise stratification; B) presence of comorbid asthma, C) normal versus low hemoglobin level; D) D-dimer level-based stratification; E) presence of acute renal failure as a complication; F) presence of heart failure as a complication. ^*Statistically significant at p<0.05. NA: not applicable, because of lack of event in the specified cohort at the 50th percentile.

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Table 1

- Socio-demographic characteristics, chronic medical illnesses, home medications, presenting coronavirus disease symptoms, and baseline vital signs of the study subjects (N=248).

Variable	n	%
Age,mean ±SD (range)^*	49.38 ±15.46 (18 – 93)
*Gender*
Female	60	24.2
Male	188	75.8
*Nationality*
Non-Saudi	155	62.5
Saudi	93	37.5
*Ethnicity*
Arab	138	55.7
East Asian and Southeast Asian	17	6.9
South Asian	73	29.4
Black	16	6.5
White	4	1.6
*Employment status*
Hhealthcare worker	12	4.8
Others	236	95.2
Body mass index, mean ±SD (range)^*	29.2 ±6.42 (18.4 –52.0)
*Obesity*
No	221	89.1
Yes	27	10.9
*Home medications*
Anti-hypertensive drugs	72	29.0
Antibiotics “before admission”	10	4.0
Anticoagulants	6	2.4
Steroids^*	4	1.6
Hypoglycemic drugs (oral hypoglycemics)	42	16.9
Hypoglycemic drugs (insulin)	43	17.3
*Chronic medical illnesses*
Chronic cardiac disease	24	9.7
Hypertension	74	29.8
Diabetes mellitus type I	17	6.9
Diabetes mellitus type II	69	27.8
Asthma	6	2.4
Renal diseases	9	3.6
Hepatic diseases	2	0.8
Neurological disorders	5	2.0
Malignancy	1	0.4
*Presenting COVID-19 symptoms*
Fever	168	67.7
Cough	52	31.1
Sore throat	30	12.1
Shortness of breath	135	54.4
Chest pain	16	6.5
Fatigue	9	3.6
Muscle ache	13	5.2
Runny nose	13	5.2
Wheeze	2	0.8
Low chest wall indrawing	2	0.8
Headache	25	10.1
Altered consciousness	4	1.6
Loss of smell sensation	11	4.4
Loss of taste sensation	12	4.8
*Baseline vital signs*	mean ±SD (range)
Temperature (Celsius)^*	37.32 ± 0.75 (36-39.4)
Respiratory rate^*	20.65 ±4.31(9-40)
Heart rate^*	92.71 ±16.50 (39-153)
Systolic blood pressure^*	128.98 ±16.87 (90-191)
Diastolic blood pressure^*	73.99 ±10.81(41-115)
Oxygen saturation (%)^*	95.02 ± 6.91(20-100)

↵ ^* The variable has missing data. SD: standard deviation

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Table 2

- Distribution of survival status in relation to the demographics, chronic medical illnesses, and COVID-19 symptoms in the study population (N=248).

Parameter	Survivals		Non-survivors		Long rank test	P-value
Parameter	n	%	n	%	Long rank test	P-value
Age
<50 years	111	89.5	13	10.5	5.0	0.03^*
50+ years	91	74.0	32	26.0	5.0	0.03^*
Gender
Female	48	80.0	12	20.0	0.24	0.62
Male	155	82.5	33	17.6	0.24	0.62
*Chronic medical illnesses*
Chronic cardiac disease
No	190	84.8	34	15.2	10.05	0.002^*
Yes	13	54.2	11	45.8	10.05	0.002^*
Hypertension
No	149	85.6	25	14.4	3.33	0.06
Yes	54	73.0	20	27.0	3.33	0.06
Diabetes mellitus
No	141	87.0	21	13.0	4.87	0.08
Type I	8	47.1	9	52.9
Type II	54	78.3	15	21.7
Asthma
No	200	82.6	42	17.4	4.75	0.03^*
Yes	3	50.0	3	50.0	4.75	0.03^*
Renal disease
No	199	83.3	40	16.7	1.18	0.27
Yes	4	44.4	5	55.6	1.18	0.27
Hepatic disease
No	202	82.1	44	17.9	0.08	0.78
Yes	1	50.0	1	50.0	0.08	0.78
Neurological disorder
No	199	81.9	44	18.1	0.24	0.62
Yes	4	80.0	1	20.0	0.24	0.62
Malignancy
No	202	81.8	45	18.2	0.27	0.60
Yes	1	100.0	0	0.0	0.27	0.60
*Presenting COVID-19 symptoms*
Fever
No	75	93.8	5	6.3	4.49	0.03^*
Yes	128	76.2	40	23.8	4.49	0.03^*
Cough
No	94	81.7	21	18.3	0.24	0.62
Yes	41	78.9	11	21.2	0.24	0.62
Sore throat
No	176	80.7	42	19.3	0.01	0.94
Yes	27	90.0	3	10.0	0.01	0.94
Runny nose
No	191	81.3	44	18.7	0.57	0.45
Yes	12	92.3	1	7.7	0.57	0.45
Wheeze
No	201	81.7	45	18.3	0.81	0.36
Yes	2	100.0	0	0.0	0.81	0.36
Shortness of breath
No	102	90.3	11	9.7	7.35	0.007^*
Yes	101	74.8	34	25.2	7.35	0.007^*
Fatigue
No	195	81.6	44	18.4	0.03	0.85
Yes	8	88.9	1	11.1	0.03	0.85
Muscle ache
No	192	81.7	43	18.3	2.95	0.08
Yes	11	84.6	2	15.4	2.95	0.08

↵ ^* Statistically significant at p<0.05.

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Table 3

- Distribution of survival status in relation to baseline blood work-ups in the study individuals (N=248).

Parameter	Survivals		Non-survivors		Long rank test	P-value
Parameter	n	%	n	%	Long rank test	P-value
*Hemoglobin*
Normal	165	89.2	20	10.8	6.49	0.01^*
Low	38	60.3	25	39.7	6.49	0.01^*
*White blood cells*
Normal	12	92.3	1	7.7	1.17	0.28
Leukocytosis	188	81.0	44	19.0	1.17	0.28
*Ferritin*
Normal	33	97.1	1	2.9	2.82	0.09
High	48	61.5	30	38.5	2.82	0.09
*Platelets*
Low	36	80.0	9	20.0	2.54	0.28
Normal	142	80.7	34	19.3
High	21	91.3	2	8.7
*aPTT*
Low	13	92.9	1	7.1	3.83	0.14
Normal	102	77.3	30	22.7
High	7	33.3	14	66.7
*PTT*
Normal	88	81.5	20	18.5	2.26	0.13
High	33	56.9	25	43.1	2.26	0.13
*INR*
Low	18	78.3	5	21.7	0.31	0.85
Normal	39	76.5	12	23.5
High	65	69.9	28	30.1
*D-Dimer*
Normal	52	100.0	0	0.0	9.08	0.002^*
High	151	77.0	45	23.0	9.08	0.002^*
*Glucose*
Normal	51	86.4	8	13.6	1.92	0.16
High	82	70.1	35	29.9	1.92	0.16
*Hemoglobin A1C*
Normal	9	100.0	0	0.0	0.62	0.43
High	36	83.7	7	16.3	0.62	0.43

↵ ^* Statistically significant at p<0.05. PTT: partial thromboplastin time, aPTT: activated partial thromboplastin time, INR: international normalized ratio

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Table 4

- Distribution of survival status in relation to management protocol, complications, and treatment options in the study participants (N=248)

Parameter	Unit	Survivals		Non-survivors		Long rank test	P-value
Parameter	Unit	n	%	n	%	Long rank test	P-value
*Management protocol*
Intensive care unit admission	No	158	99.4	1	0.6	32.25	<0.001^*
Intensive care unit admission	Yes	45	50.6	44	49.4	32.25	<0.001^*
Non-invasive ventilation	No	163	81.1	38	18.9	3.17	0.07
Non-invasive ventilation	Yes	40	85.1	7	14.9	3.17	0.07
Invasive ventilation	No	201	94.8	11	5.2	73.57	<0.001^*
Invasive ventilation	Yes	2	5.6	34	94.4	73.57	<0.001^*
Inserted tracheostomy	No	202	86.7	31	13.3	16.11	<0.001^*
Inserted tracheostomy	Yes	1	6.7	14	93.3	16.11	<0.001^*
Renal replacement therapy	No	200	83.0	41	17.0	0.17	0.67
Renal replacement therapy	Yes	3	42.9	4	57.1	0.17	0.67
*Complications*
Pneumothorax	No	203	83.2	41	16.8	7.5	0.006^*
Pneumothorax	Yes	0	0.0	4	100.0	7.5	0.006^*
Pleural effusion	No	197	82.8	41	17.2	1.13	0.28
Pleural effusion	Yes	6	60.0	4	40.0	1.13	0.28
Pulmonary embolism	No	199	84.0	38	16.0	1.89	0.18
Pulmonary embolism	Yes	4	36.4	7	63.6	1.89	0.18
Cardiac arrest	No	203	99.0	2	1.0	121.3	<0.001^*
Cardiac arrest	Yes	0	0.0	43	100.0	121.3	<0.001^*
Cardiac ischemia	No	202	83.5	40	16.5	6.31	0.01^*
Cardiac ischemia	Yes	1	16.7	5	83.3	6.31	0.01^*
Cardiac arrhythmia	No	202	83.1	41	16.9	2.16	0.14
Cardiac arrhythmia	Yes	1	20.0	4	80.0	2.16	0.14
Heart failure	No	203	83.5	40	16.5	67.48	<0.001^*
Heart failure	Yes	0	0.0	5	10.0	67.48	<0.001^*
Cerebrovascular stroke	No	203	83.5	40	16.5	12.09	<0.001^*
Cerebrovascular stroke	Yes	0	0.0	5	100.0	12.09	<0.001^*
Liver dysfunction	No	189	81.5	43	18.5	0.59	0.44
Liver dysfunction	Yes	14	87.5	2	12.5	0.59	0.44
Acute renal failure	No	203	85.3	35	14.7	22.97	<0.001^*
Acute renal failure	Yes	0	0.0	10	100.0	22.97	<0.001^*
Bacteremia	No	202	83.5	40	16.5	5.93	0.01^*
Bacteremia	Yes	1	16.7	5	83.3	5.93	0.01^*
*Treatments*
Ribavirin	No	182	81.6	41	18.4	0.34	0.55
Ribavirin	Yes	21	84.0	4	16.0	0.34	0.55
Lopinavir-Ritonavir	No	159	83.3	32	16.8	0.15	0.69
Lopinavir-Ritonavir	Yes	44	77.2	13	22.8	0.15	0.69
Chloroquine	No	129	79.1	34	20.9	3.38	0.06
Chloroquine	Yes	198	81.5	45	18.5	3.38	0.06
Corticosteroids	No	161	83.0	33	17.0	0.10	0.74
Corticosteroids	Yes	42	77.8	12	22.2	0.10	0.74
Heparin	No	123	89.1	15	10.9	2.64	0.10
Heparin	Yes	80	72.7	30	27.3	2.64	0.10

↵ ^* Statistically significant at p<0.05.

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Table 5

- Cox proportional hazard model for the predictors of time-to-death among the hospitalized COVID-19 patients (N=248).

Variable	HR	95% CI	P-value	aHR	95% CI	P-value
Age – Ref: <50 years
50+ years	2.05	1.07 – 3.94	0.03^*	2.26	1.03 – 4.91	0.04^*
Asthma – Ref: No
Yes	3.43	1.04 – 11.29	0.04^*	3.87	1.09 – 13.75	0.04^*
Acute renal failure – Ref: No
Yes	4.86	2.35 – 10.06	<0.001^*	4.75	2.10 – 10.74	<0.001^*
Hemoglobin – Ref: Normal
Low	2.18	1.16 – 4.07	0.01^*	1.82	0.89 – 3.69	0.09
Heart failure – Ref: No
Yes	31.37	8.56 – 114.97	<0.001^*	50.12	11.95 – 210.20	<0.001^*
D-Dimer – Ref: Normal
High	1.02	0.89 – 1.04	>0.05	1.01	0.99 – 1.03	0.05