Predictors of mortality among critical COVID-19 patients admitted to the intensive care unit in the Sulaimani governorate in 2021, Iraq

Sherzad Ali Ismael

doi:10.15218/zjms.2024.008

Authors

Sherzad Ali Ismael Kurdistan Board for Medical Specialties, Erbil, Iraq.

DOI:

https://doi.org/10.15218/zjms.2024.008

Keywords:

COVID-19, Mortality, Sulaimani, Iraq

Abstract

Background and objective: There are many factors that inﬂuence mortality in critically ill patients with COVID-19 infection in the intensive care unit. The aim of this study was to investigate the risk factors that predict the mortalities of critical COVID-19 patients admitted to the intensive care unit in Sulaimani in 2021.

Methods: This is an observational retrospective study of critically ill patients with COVID-19 pneumonia admitted to the main intensive care unit of the Sulaimani government between June and December 2020. Overall baseline characteristics are presented based on the patient's survivors versus non-survivors. Mann-Whitney U test was used to compare whether there is a difference between survivors and non-survivors for the independent basic characteristics of the patients. Binary logistic regression was used to identify the predicted factors of survivors.

Results: A total of 220 patients were admitted to the intensive care unit, of whom 167 died, with a case fatality rate of 75.9%. The risk factors that predicted mortality in critical COVID-19 patients were an increasing age of more than 59 years (P-value = 0.008), comorbidities (P-value = 0.038), and a lack of use of antiviral drugs (P-value = 0.011). Whereas the factors significantly predicted a reduction in mortality were increasing oxygen saturation (P-value <0.001), systolic blood pressure (P-value = 0.002), non-invasive mechanical ventilation (facemask) (P-value = 0.001), and continuous positive airway pressure (P-value = 0.003).

Conclusion: The risk factors that predicted mortality in critical COVID-19 patients were increasing age, comorbidities, and a lack of use of antiviral drugs. Whereas increasing oxygen saturation, systolic blood pressure, non-invasive mechanical ventilation (facemask), and continuous positive airway pressure significantly predicted a reduction in the likelihood of death.

Metrics

Metrics Loading ...

References

World Health Organization. Coronavirus disease (COVID‐19) Pandemic, 2020. https://www.who.int/emergencies/diseases/novel‐coronavirus‐2019 (accessed 23/06/2022).

World Health Organization. WHO Coronavirus Disease (COVID‐19) Dashboard, 2020. https://covid19.who.int/ (accessed 23/06/2022).

Atlas GIS and IT. Coronavirus COVID-19 GeoHub-Iraq. https://coronavirus-covid-19-iraq-atlasgis.hub.arcgis.com. (Accessed 23/06/2022).

Kurdistan Regional Government. COVID-19 in the Kurdistan region. https://coronavirus-covid-19-iraq-atlasgis.hub.arcgis.com (Accessed 23/06/2022).

Ramzi ZS. Risk Factors of Mortality among COVID-19 Patients in Sulaimaniyah City Kurdistan Region Iraq. Am J Phytomed Clin Ther 2021; 9(8).

Republic of Iraq Presidency of Council of Ministers, National Investment Commission. Investment map of Iraq 2022. [Internet]. Available from: Www.investpromo.gov.iq. Accessed 24/6/2022.

Armstrong RA, Kane AD, Cook TM. Outcomes from intensive care in patients with COVID‐19: a systematic review and meta‐analysis of observational studies. Anaesthesia 2020; 75: 1340–9. DOI: 10.1111/anae.15201 (Accessed 23/06/2022).

Armstrong RA, Kane AD, Cook TM. Decreasing mortality rates in ICU during the COVID‐19 pandemic. Anaesthesia 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436742 (Accessed 23/06/2022).

Alhasan KA, Shalaby MA, Temsah M-H, Aljamaan F, Shagal R, AlFaadhel T, et al. Factors that inﬂuence mortality in critically ill patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia. Healthcare 2021;9: 1608. DOI:10.3390/healthcare9121608 (accessed 23/06/2022).

Viseslav P, Slobodan K, Natasa M, Nina R, Aleksandra A, Marija M, et al. Predictors of Mortality in Critically Ill COVID-19 Patients Demanding High Oxygen Flow: A Thin Line between Inflammation, Cytokine Storm, and Coagulopathy. Oxid Med Cell Longev 2021. DOI:10.1155/2021/6648199

Ashraf MA, Sherafat A, Naderi Z, Sami R, Soltaninejad F, Khodadadi S, et al. Association of systemic complications with mortality in coronavirus disease of 2019: A cohort study on intensive care unit patients. J Res Med Sci 2022; 27.

Gopalan N, Senthil S, Prabakar NL, Senguttuvan T, Bhaskar A, Jagannathan M, et al. Predictors of mortality among hospitalized COVID-19 patients and risk score formulation for prioritizing tertiary care—An experience from South India. PLOS ONE 2022; 17(2): e0263471. DOI:10.1371/journal.pone.0263471.

Muhammed BT, Awlla AH, Murad SH, Ahmad SN. Prediction of CoVid-19 mortality in Iraq-Kurdistan by using Machine learning. UHD Journal of Science and Technology 2021; 5(1):66–70. DOI:10.21928/uhdjst.v5n1y2021.pp66-70

Darweesh O, Abdulrazzaq GM, Al-Zidan RN, Bebane P, Merkhan M, Aldabbagh R, et al. Evaluation of the Pharmacologic Treatment of COVID-19 Pandemic in Iraq. Curr Pharmacol Rep 2021;7(4):171–8. DOI:10.1007/s40495-021-00262-9. Epub 2021. PMID: 34377628; PMCID: PMC8339216.

Bosnic, Zoran & Kononenko, Igor. An overview of advances in reliability estimation of individual predictions in machine learning. Intell. Data Anal 2009; 13: 385–401. DOI:10.3233/IDA-2009-

Martinot M, Eyriey M, Gravier S, Bonijoly T, Kayser D, Ion C, et al. Predictors of mortality, ICU hospitalization, and extrapulmonary complications in COVID-19 patients. Infectious Diseases Now 2021; 51(6):518–25. DOI:10.1016/j.idnow.2021.07.002.

Armstrong RA, Kane AD, Kursumovic E, Oglesby FC, Cook TM. Mortality in patients admitted to intensive care with COVID-19: an updated systematic review and meta-analysis of observational studies. Anaesthesia 2021; 76(4):537–48. DOI:10.1111/anae.15425. Epub 2021. PMID:33525063; PMCID: PMC8013495.

Liu J, Zhang S, Wu Z, Shang Y, Dong X, Li G, et al. Clinical outcomes of COVID-19 in Wuhan, China: a large cohort study. Ann of Intensive Care 2020; 10(1):1–21. DOI:10.1186/s13613-020-00706-3

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet 2020; 395(10229):1054–62. DOI:10.1016/S0140-6736(20)30566-3.

Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol 2020; 146(1):110–8. DOI:10.1016/j.jaci.2020.04.006

Karagiannidis C, Mostert C, Hentschker C, Voshaar T, Malzahn J, Schillinger G, et al. Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study. Lancet Respir Med 2020; 8(9):853–62. DOI:10.1016/S2213-2600(20)30316-7.

Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ 2020; 369. DOI:10.1136/bmj.m1985

Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. The Lancet 2020; 395(10239):1763–70. DOI:10.1016/S0140-6736(20)31189-2

Australian and New Zealand Intensive Care Society. Anzics core COVID‐19 Report 2020. https://www.anzics.com.au/annual‐reports/ (Accessed 11/12/2020).

World Health Organization. WHO provides support to bridge shortfall in oxygen supplies in Iraq. 2020. http://www.emro.who.int/iraq/news/who-provides-support-to-bridge-the-shortfall-in-oxygen-supplies-in-iraq.html

Intensive Care National Audit and Research Centre. ICNARC report on COVID-19 in critical care 2020. https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports (Accessed 29/06/2022).

Intensive Care National Audit and Research Centre. Case Mix Programme Summary Statistics 2018-2019. 2019. https://www.icnarc.org/OurAudit/Audits/Cmp/Reports/Summary-Statistics (accessed 24/06/2023).

Kastora S, Patel M, Carter B, Delibegovic M, Myint PK. Impact of diabetes on COVID-19 mortality and hospital outcomes from a global perspective: An umbrella systematic review and meta-analysis. Endocrinol Diabetes Metab 2022;5(3):e00338. DOI:10.1002/edm2.338. Epub 2022. PMID: 35441801; PMCID: PMC9094465.

Alnor A, Sandberg MB, Gils C, Vinholt PJ. Laboratory tests and outcome for patients with coronavirus disease 2019: a systematic review and meta-analysis. J Appl Lab Med 2020; 5(5):1038–49.

Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect 2020; 81(2):e16–25. DOI:10.1016/j.jinf.2020.04.021

Henry BM, De Oliveira MH, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med 2020; 58(7):1021–8. DOI:10.1515/cclm-2020-0369

Becker RC. COVID-19 update: Covid-19-associated coagulopathy. J Thromb Thrombolysis 2020; 50(1):54–67. DOI:10.1007/s11239-020-02134-3.

Cantini F, Goletti D, Petrone L, Najafi Fard S, Niccoli L, Foti R. Immune therapy, or antiviral therapy, or both for COVID-19: a systematic review. Drugs. 2020; 80(18):1929–46.

Perveen RA, Nasir M, Talha K A, Selina F, Islam MA, et al. "Systematic review on current antiviral therapy in COVID-19 pandemic." The Medical Journal of Malaysia 2020; 75(6):710–6.

Kim SB, Huh K, Heo JY, Joo EJ, Kim YJ, Choi WS, et al. Interim Guidelines on Antiviral Therapy for COVID-19. Infect Chemother 2020; 52(2):281–304. DOI:10.3947/ic.2020.52.2.281. Epub 2020 Apr 23. PMID: 32342676; PMCID: PMC7335642.

Negrut N, Codrean A, Hodisan I, Bungau S, Tit DM, Marin R, et al. "Efficiency of antiviral treatment in COVID 19". Experimental and Therapeutic Medicine 2021; 21(6):648.

Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA 2020. Epub 2020/04/23. pmid:32320003.

Wang Y, Lu X, Chen H, Chen T, Su N, Huang F, et al. Clinical Course and Outcomes of 344 Intensive Care Patients with COVID-19. Am J Respir Crit Care Med 2020. Epub 2020/04/09. pmid:32267160.