PATIENT CHARACTERISTICS AND RISK FACTORS CONTRIBUTING TO DISEASE PROGRESSION AMONG HOSPITALISED PATIENTS WITH COVID-19: LESSON FROM MALAYSIA
DOI:
https://doi.org/10.31436/ijiok.v1i1.6Keywords:
COVID-19, disease progression, risk factors, patient characteristics, MalaysiaAbstract
Background: Patients who were hospitalised with severe COVID-19 infection could progress to severe conditions due to various factors, whereas some patients may recover to mild conditions quickly. There was limited information regarding characteristics and factors affecting disease progression in this population in Malaysia. This study aimed to investigate patient characteristics and risk factors contributing to disease progression among COVID-19 patients during hospitalisation.
Methods: A retrospective cross-sectional study using electronic medical record data from COVID-19 patients admitted to two public hospitals in East Coast Malaysia from February 2020 to August 2021 was conducted. This study included patients with asymptomatic or mild condition (stage 1 – stage 3) upon hospital admission and progressed to severe condition (stage 4 – stage 5) during hospitalisation.
Results: A total of 163 patients were included (57% male) with the age of (mean±SD, 62.3 ±14.0 years). Multivariable logistic regression associated with COVID-19 disease progression included elderly (OR, 1.06; 95% CI, 1.04, 1.08; p = ≤0.05), diabetes mellitus (OR, 2.27; 95% CI, 1.27, 4.06; p = 0.006), chronic kidney disease (OR, 4.87; 95% CI, 1.92, 12.38; p=0.001), and presented with more than three COVID-19 symptoms (OR, 9.80; 95% CI, 6.08-15.81, p = ≤0.05).
Conclusion: Risk factors for COVID-19 disease progression included elderly patients, comorbidities of diabetes mellitus, chronic kidney disease or more than three COVID-19 symptoms. Close monitoring and early intervention should be implemented for these patients to prevent the disease progression and poor prognosis.
References
Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Napoli RD. (2021). Features, Evaluation, and Treatment of Coronavirus (COVID-19). Treasure Island (FL): StatPearls Publishing. Available from https://www.ncbi.nlm.nih.gov/books/NBK554776/
Elflein J. (2021). Coronavirus (COVID-19) disease pandemic – statistics and facts. Statista. https://www.statista.com/topics/5994/the-coronavirus-disease-covid-19-outbreak/
Choi MH, Ahn H, Ryu HS, Kim B, Jang J, Jung M, Kim J, Jeong SH. (2020). Clinical characteristics and disease progression in early-stage COVID-19 patients in South Korea. Journal of Clinical Medicine, 9(6):1959. https://doi.org/10.3390%2Fjcm9061959 DOI: https://doi.org/10.3390/jcm9061959
Centers for Disease Control and Prevention. (2021, February 12). Interim clinical guidance for management of patients with confirmed coronavirus disease (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
Daniel, WW. (2005). Biostatistics: A foundation for analysis in the health sciences. John Wiley & Sons, Inc.
Sim BLH, Chidambaram SK, Wong XC, Panthmanathan, MD, Peariasamy KM, Hor CP, … Goh PP. (2020). Clinical characteristics and risk factors for severe COVID-19 infection. The Lancet Regional Health – Western Pacific 4. https://doi.org/10.1016/j.lanwpc.2020.100055 DOI: https://doi.org/10.1016/j.lanwpc.2020.100055
Johns Hopkins University & Medicine. (2022). Mortality analyses. https://coronavirus.jhu.edu/data/mortality
Dessie ZG, Zewotir T. (2021). Mortality-related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423117 patients. BioMed Central (BMC) Infectious Diseases, 21: 855. https://doi.org/10.1186%2Fs12879-021-06536-3
Ministry of Health Malaysia. (2020). Annex 2e: Clinical management of confirmed COVID-19 case in adult and paediatric. Retrieved from http://covid-19.moh.gov.my/garis-panduan/garis-panduan-kkm/Annex_2e_Clinical_Management_For_Confirmed_COVID-19_in_Adult_and_Paed.28.09.20.pdf
Fan C, Lu W, Li K, Ding Y, Wang J. (2021). ACE2 expression in kidney and testis may cause kidney and testis infection in COVID-19 patients. Frontiers in Medicine, 7, 563893. https://doi.org/10.3389/fmed.2020.563893 DOI: https://doi.org/10.3389/fmed.2020.563893
John KJ, Nayar J, Mishra AK, Selvaraj V, Khan MS, Lal A. (2021). In-hospital clinical complications of COVID-19: a brief overview. Future Virol. https://doi.org/10.2217%2Ffvl-2021-0200 DOI: https://doi.org/10.2217/fvl-2021-0200
Hobbs ALV, Turner N, Omer I, Walker MK, Beaulieu RM, Sheikh M, Spires SS, Fiske CT, Dare R, Goorha S, Thapa P, Gnann J, Wright J, Nelson GE. (2021). Risk factors for mortality and progression to severe COVID-19 disease in the Southeast region in the United States: A report from SEUS Study group. Infection Control & Hospital Epidemiology, 42(12), 1464-1472. doi:10.1017/ice.2020.1435 DOI: https://doi.org/10.1017/ice.2020.1435
Damayanthi H, Prabani K, Weerasekara I. (2021). Factors associated for mortality of older people with COVID-19: A systematic review and meta-analysis. Gerontology & geriatric medicine, 7, 23337214211057392. https://doi.org/10.1177/23337214211057392 DOI: https://doi.org/10.1177/23337214211057392
Ponnappan S, Ponnappan U. (2011). Aging and immune function: molecular mechanisms to interventions. Antioxidants & redox signaling, 14(8), 1551–1585. https://doi.org/10.1089/ars.2010.3228 DOI: https://doi.org/10.1089/ars.2010.3228
Sharif N, Opu RR, Ahmed SN, Sarkar MK, Jaheen R, Daullah MU, … Talukder AA. (2021). Prevalence and impact of comorbidities on disease prognosis among patients with COVID-19 in Bangladesh: a nationwide study amid the second wave. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 102148. https://doi.org/10.1016/j.dsx.2021.05.021 DOI: https://doi.org/10.1016/j.dsx.2021.05.021
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. The Lancet, 395(10223), 507-513. https://doi.org/10.1016/S0140-6736(20)30211-7
Soares RCM, Mattos LR, Raposo LM. (2020). Risk factors for hospitalisation and mortality due to COVID-19 in Espirito Santo State, Brazil. The American Journal of Tropical Medicine and Hygiene, 103(3): 1184-1190. 10.4269/ajtmh.20-0483. DOI: https://doi.org/10.4269/ajtmh.20-0483
Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, … Song Y. (2020). Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China. Journal of the American Medical Association (JAMA) Internal Medicine, 180(7):934–943. doi:10.1001/jamainternmed.2020.0994 DOI: https://doi.org/10.1001/jamainternmed.2020.0994
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang Li. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. The Lancet, 395(10223), 507-513. https://doi.org/10.1016/S0140-6736(20)30211-7m DOI: https://doi.org/10.1016/S0140-6736(20)30211-7
Dessie ZG, Zewotir T. (2021). Mortality-related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423117 patients. BioMed Central (BMC) Infectious Diseases, 21: 855. https://doi.org/10.1186%2Fs12879-021-06536-3 DOI: https://doi.org/10.1186/s12879-021-06536-3
Nguyen NT, Chinn J, Ferrante MD, Kirby KA, Hohmann SF, Amin A. (2021). Male gender is a predictor of higher mortality in hospitalised adults with COVID-19. Plos one, 16(7): e0254066. https://doi.org/10.1371/journal.pone.0254066 DOI: https://doi.org/10.1371/journal.pone.0254066
Peckham H, de Gruijter NM, Raine C, Radziszewska A, Ciurtin C, Wedderburn LR, Rosser EC, Webb K, Deakin CT. (2020). Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nature Communications, 11, 6317. https://doi.org/10.1038/s41467-020-19741-6 DOI: https://doi.org/10.1038/s41467-020-19741-6
Bwire, G. M. (2020). Coronavirus: why men are more vulnerable to COVID-19 than women? Springer Nature Comprehensive Clinical medicine, 2 (7): 874-876. https://dx.doi.org/10.1007%2Fs42399-020-00341-w DOI: https://doi.org/10.1007/s42399-020-00341-w
Ismail SNA, Zaki IAH, Noordin ZM, Hussin NSM, Ming LC, Zulkifly HH. (2022). Clinical characteristics and risk factors for mortality in patients with COVID-19: A retrospective nationwide study in Malaysia. Proceedings of Singapore Healthcare, 1-8. https://doi.org/10.1177%2F20101058221085743 DOI: https://doi.org/10.1177/20101058221085743
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, … Cao B. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet, 395(10229), 1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3 DOI: https://doi.org/10.1016/S0140-6736(20)30566-3
He X, Lau EHY, Wu P. Deng X, Wang J, Hao X, Lau YC, Wong, JY, Guan Y, Tan X, Mo X, Chen Y, Liao B, Chen W, Hu F, Zhang Q, Zhong M, Wu Y, Zhao L, Zhang F, Cowling BJ, Li F, Leung GM. (2020). Temporal dynamics in viral shedding and transmissibility of COVID-19. Nature Medicine, 26, 672–675. https://doi.org/10.1038/s41591-020-0869-5 DOI: https://doi.org/10.1038/s41591-020-0869-5
Salah HM, Sharma T, Mehta J. (2020). Smoking doubles the mortality risk in COVID-19: A meta-analysis of recent reports and potential mechanisms. Cureus, 12(10), e10837. https://doi.org/10.7759%2Fcureus.10837 DOI: https://doi.org/10.7759/cureus.10837
Rastad H, Ejtahed H, Shafiee G, Safari A, Shahrestanaki E, Khodaparast Z, … Qorbani M. (2021). The risk factors associated with COVID-19-related death among patients with end-stage renal disease. BMC Nephrology, 22, 33. https://doi.org/10.1186/s12882-020-02221-w DOI: https://doi.org/10.1186/s12882-020-02221-w
Menon T, Gandhi SAQ, Tariq W, Sharma R, Sardar S, Arshad AM, Adhikari R, Ata F, Kataria S, Singh R. (2021). Impact of chronic kidney disease on severity and mortality in COVID-19 patients: a systematic review and meta-analysis. Cureus, 13(4): e14279. https://doi.org/10.7759/cureus.14279 DOI: https://doi.org/10.7759/cureus.14279
Sabaghian T, Kharazmi AB, Ansari A, Omidi F, Kazemi SN, Hajikhani B, Vaziri-Harami R, Tajbakhsh A, Omidi S, Haddadi S, Bonjar AHS, Nasiri MJ, Mirsaridi M. (2022). COVID-19 and acute kidney injury: a systematic review. Frontiers in Medicine, 9:705908. https://doi.org/10.3389/fmed.2022.705908 DOI: https://doi.org/10.3389/fmed.2022.705908
Chou C, Wang S, Liang C, Chang C, Liu J, Wang I, Hsiao L, Muo C, Huang C, Wang R. (2014). Risk of pneumonia among patients with chronic kidney disease in outpatient and inpatient settings: a nationwide population-based study. Medicine (Baltimore), 93(27): e174. https://doi.org/10.1097/md.0000000000000174 DOI: https://doi.org/10.1097/MD.0000000000000174
Kuswardhani RAT, Henrina H, Pranata R, Lim MA, Lawrensia S, Suastika K. (2020). Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and meta-analysis. Diabetes and Metabolic Syndrome: Clinical Research and Reviews, 2103-2109. https://doi.org/10.1016/j.dsx.2020.10.022 DOI: https://doi.org/10.1016/j.dsx.2020.10.022
Saleh MA, Alotaibi N, Schrapp K, Alsaber A, Pan J, Almutairi F, ... Alroomi M. (2022). Risk factors for mortality in patients with COVID-19: The Kuwait Experience. Medical Principals and Practice, 117, 1–7. doi: 10.1159/000522166 DOI: https://doi.org/10.1159/000522166
Almeida-Pititto B, Dualib PM, Zajdenverg L, Dantas JR, Souza FD, Rodacki M, Bertoluci MC, Brazillian Diabetes Society Study Group. (2020). Severity and mortality of COVID-19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis. Diabetology & Metabolic Syndrome, 12:75. https://doi.org/10.1186/s13098-020-00586-4 DOI: https://doi.org/10.1186/s13098-020-00586-4
Ministry of Health Malaysia. (2022). COVIDNOW in Malaysia. Retrieved from https://covidnow.moh.gov.my/
World Health Organization. (2022). Ageing and health. Retrieved from https://www.who.int/news-room/fact-sheets/detail/ageing-and-health#:~:text=By%202030%2C%201%20in%206,will%20double%20
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 IIUM Press
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.