Predictors of Illness Severity in COVID-19 Cases in Saudi Arabia

Abstract

Purpose

Multiple studies worldwide have reported the clinical and epidemiological features of coronavirus disease 2019 (COVID-19), with limited reports from the Middle East. This study describes the clinical and epidemiological features of COVID-19 cases in the Eastern Province of Saudi Arabia and identified factors associated with the severity of illness.

Patients and Methods

This was an observational study of 341 COVID-19 cases. These cases were reported in the first three months after the first case in the country was identified. Clinical and demographic data were analyzed and described to identify the effects of age, sex, and ethnicity on illness severity. In addition, the duration of viral shedding and cycle threshold (Ct) values of real-time PCR were evaluated as predictors of severity.

Results

The median age was 45 years. Males were twice as likely to be infected than females (p <0.0001). The duration of viral shedding ranged from 9 to 36 days. The most common clinical presentations include fever, shortness of breath, cough, myalgia, sore throat, vomiting, and headache. Critical cases were significantly higher in men (23% vs 8.7%), senior adults (>65 years), individuals of Bengali ethnicity, and in patients with comorbidities including diabetes, hypertension, and dyslipidemia (p =0.001). The case fatality rate was found to be 10%. The fatality was significantly higher in males than females (13.8% vs 2.6%), and in Asians (17.9%) than Arabs (6%) and Africans (0) (p =0.002). No association was found between viral load, represented by the RT-PCR cycle threshold (Ct) values, and severity of illness.

Conclusion

Age, sex, and ethnicity are important predictors of COVID-19 severity. The cycle threshold (Ct) of the SARS-CoV-2 RT-PCR test cannot be used as a predictor of the criticality of illness.

Keywords:

• factors
• ethnicity
• Ct value
• Arabs
• virus shedding

Acknowledgments

The research team is grateful to the Deanship of Scientific Research at Imam Abdulrahman Bin Faisal University for funding the project and to the Information Technology Department and the Department of Laboratory Medicine at King Fahd Hospital of the university for their cooperation in data acquisition, data collection, and curation.

Data Sharing Statement

All data analyzed in the study are available upon reasonable request from the corresponding author.

Ethics Approval and Informed Consent

Ethical approval for the study was obtained from the Institutional Review Board at Imam Abdulrahman Bin Faisal University (IRB-2020-01-150). Written patient consent was not requested by the IRB committee due to the retrospective nature of the study and that no patients identifiable information is presented. Patients’ confidentiality in maintained throughout the study and the study doesn’t carry any additional risk to patients. Furthermore, participation in the study did not interfere with patients management and all investigations included and analyzed were part of patients management as per the hospital protocols.

Disclosure

The authors report no conflicts of interest in this work.