Factors Associated with Mortality Among Hospitalized Adults with COVID-19 Pneumonia at a Private Tertiary Hospital in Tanzania: A Retrospective Cohort Study

Figures & data

Table 1 Demographic and Clinical Characteristics of Patients

Variable	N	Overall, N = 157^a	Patient Outcome		p-value^b
			Survivor, N = 107^a	Non-Survivors, N = 50^a
Age	157	52 (42–61)	48 (37–57)	60 (49–69)	<0.001
< 45		52 (33%)	44 (41%)	8 (16%)
45–64		71 (45%)	49 (46%)	22 (44%)
65–74		27 (17%)	11 (10%)	16 (32%)
>75		7 (4.5%)	3 (2.8%)	4 (8.0%)
Sex	157				0.049
Female		22 (14%)	11 (10%)	11 (22%)
Male		135 (86%)	96 (90%)	39 (78%)
Race	157				<0.001
African		72 (46%)	45 (42%)	27 (54%)
South Asians		53 (34%)	32 (30%)	21 (42%)
Chinese		9 (5%)	9 (8.4%)	0 (0%)
Others		23 (15%)	21 (9.6%)	2 (4.0%)
Comorbids	157
None		62 (39%)	58 (54%)	4 (8.0%)	< 0.0001
DM		18 (11%)	15 (14%)	3 (6.0%)	0.1418
HTN		12 (7.6%)	9 (8.4%)	3 (6.0%)	0.5963
HIV		4 (2.5%)	1 (0.9%)	3 (6.0%)	0.0606
Asthma or COPD		9 (5.7%)	3 (2.8%)	6 (12%)	0.0209
DM & HTN		29 (18%)	14 (13%)	15 (30%)	0.0109
DM, HTN, and CKD		9 (5.7%)	6 (5.6%)	3 (6.0%)	0.9215
DM, HTN, and CAD		4 (2.5%)	0 (0%)	4 (8.0%)	0.0030
Others		10 (6.4%)	1 (0.9%)	9 (18%)	< 0.0001
BMI	134				<0.001
Healthy weight		44 (33%)	39 (45%)	5 (10%)
Overweight		40 (30%)	27 (31%)	13 (27%)
Obese		50 (37%)	20 (23%)	30 (62%)
LOS (Days)		6 (3-10)	6 (4-11)	3 (1-7)	<0.001

Notes: ^aMedian (IQR) or frequency (%) ^bWilcoxon rank sum test; Fisher’s exact test; Pearson’s Chi-squared test.

Abbreviations: DM, diabetes mellitus; HTN, hypertension; CKD, chronic kidney disease; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; BMI, body mass index; LOS, length of stay; <, less than; >, more than.

Table 2 Presenting Symptoms and Initial Vitals on Admission

Variable	N	Overall, N = 157^a	Patient Outcome		p-value^b
			Survivor, N = 107^a	Non-Survivors, N = 50^a
Symptoms
Cough	157	97 (62%)	74 (69%)	23 (46%)	0.005
Fever	157	108 (69%)	75 (70%)	33 (66%)	0.61
Difficulty breathing	157	67 (43%)	40 (37%)	27 (54%)	0.050
Malaise	157	47 (29.9%)	46 (43%)	1 (2.0%)	<0.001
Headache	157	17 (11%)	17 (16%)	0 (0%)	0.003
Gastrointestinal symptoms	157	13 (8.3%)	8 (7.5%)	5 (10%)	0.76
Others	157	9 (5.7%)	4 (3.7%)	5 (10%)	0.14
Vitals
Respiratory rate (breaths/min)	157	24 (20–30)	23 (19–26)	28 (24–33)	<0.001
Systolic blood pressure (mmHg)	157	126 (117–140)	128 (120–140)	123 (109–140)	0.11
Diastolic blood pressure (mmHg)	157	80 (70–87)	80 (74–87)	78 (60–84)	0.073
SpO2 (%)	157	92 (88–96)	94 (90–96)	88 (78–93)	<0.001
Heart rate (beats/min)	157	98 (85–110)	93 (84–105)	104 (90–120)	<0.001

Notes: ^aMedian (IQR) or frequency (%), ^bWilcoxon rank sum test; Fisher’s exact test; Pearson’s Chi-squared test.

Abbreviation: SpO2, oxygen saturation.

Table 3 Type of Initial Respiratory Support, Chest X-Ray Findings, Admitting Ward and Severity of the Disease on Admission

Variable	N	Overall, N = 157^a	Patient Outcome		p-value^b
			Survivor, N = 107^a	Non-Survivors, N = 50^a
Initial support	157				<0.001
No support		52 (33%)	50 (47%)	2 (4.0%)
Nasal prongs		25 (16%)	22 (21%)	3 (6.0%)
Face mask		12 (7.6%)	5 (4.7%)	7 (14%)
Non-rebreather mask		62 (39%)	29 (27%)	33 (66%)
Intubated		6 (3.8%)	1 (0.9%)	5 (10%)
Chest x-ray	135				0.029
Normal		20 (15%)	19 (21%)	1 (2.2%)
Bilateral patchy shadowing		46 (34%)	26 (29%)	20 (43%)
Ground glass opacities		32 (24%)	19 (21%)	13 (28%)
Interstitial abnormalities		9 (6.7%)	5 (5.6%)	4 (8.7%)
Local patchy shadowing		12 (8.9%)	9 (10%)	3 (6.5%)
Others		16 (12%)	11 (12%)	5 (11%)
Admitted to	157				<0.001
General ward		99 (63%)	85 (79%)	14 (28%)
HDU		29 (18%)	13 (12%)	16 (32%)
ICU		29 (18%)	9 (8.4%)	20 (40%)
Severity	157				<0.001
Moderate		51 (32%)	48 (45%)	3 (6.0%)
Severe		61 (39%)	48 (45%)	13 (26%)
Critical		45 (29%)	11 (10%)	34 (68%)

Notes: ^aMedian (IQR) or frequency (%), ^bFisher’s exact test; Pearson’s Chi-squared test.

Abbreviations: HDU, high dependency unit; ICU, intensive care unit.

Table 4 Laboratory Parameters on Admission

Variable	N	Overall, N = 157^a	Patient Outcome		p-value^b
			Survivor, N = 107^a	Non-Survivors, N = 50^a
WBC (10^9/L)	154	7.9 (5.7–10.8)	7.2 (5.4–9.4)	10.4 (6.3–14.9)	<0.001
< 4		8 (5.2%)	6 (5.8%)	2 (4.0%)
4–10		98 (64%)	77 (74%)	21 (42%)
> 10		48 (31%)	21 (20%)	27 (54%)
ANC (10^9/L)	154	5.9 (3.8–9.2)	5.4 (3.5–8.0)	8.3 (5.0–13.9)	<0.001
< 1.8		3 (1.9%)	3 (2.9%)	0 (0%)
1.8–6.3		81 (53%)	62 (60%)	19 (38%)
> 6.3		70 (45%)	39 (38%)	31 (62%)
ALC (10^9/L)	154	0.89 (0.65–1.45)	0.88 (0.65–1.37)	1.00 (0.67-1.63)	0.47
< 0.8		64 (42%)	44 (42%)	20 (40%)
0.8–1.0		20 (13%)	15 (14%)	5 (10%)
> 1.0		70 (45%)	45 (43%)	25 (50%)
CRP (mg/L)	151	134 (52–267)	109 (47–220)	207 (90–301)	0.004
< 50		37 (25%)	29 (28%)	8 (17%)
50–100		23 (15%)	18 (17%)	5 (10%)
100–200		37 (25%)	26 (25%)	11 (23%)
> 200		54 (36%)	30 (29%)	24 (50%)
LDH (IU/L)	139	446 (304–576)	392 (282–533)	504 (412–728)	0.002
≤ 225		16 (12%)	14 (15%)	2 (4.3%)
> 225		123 (88%)	79 (85%)	44 (96%)
D-dimer (mg/L)	134	0.68 (0.39–1.93)	0.58 (0.35–1.34)	1.44 (0.58–5.74)	<0.001
< 0.5		46 (34%)	39 (41%)	7 (18%)
0.5–1.0		32 (24%)	21 (22%)	11 (28%)
> 1.0		56 (42%)	34 (36%)	22 (55%)
Ferritin (µg/L)	118	928 (525–1843)	960 (525–1905)	829 (563–1573)	0.79
Unknown		39	21	18
< 250		19 (16%)	14 (16%)	5 (16%)
250–500		10 (8.5%)	7 (8.1%)	3 (9.7%)
> 500		88 (75%)	65 (76%)	23 (74%)
INR	72	1.15 (1.10–1.34)	1.13 (1.07–1.27)	1.25 (1.15–1.64)	0.007
0–1		4 (5.6%)	3 (6.5%)	1 (3.8%)
1.0–1.5		56 (78%)	38 (83%)	18 (69%)
> 1.5		12 (17%)	5 (11%)	7 (27%)
BUN (mmol/L)	118	5.9 (3.9–9.9)	5.0 (3.3–7.6)	8.2 (4.8–12.4)	<0.001
≤ 9.5		87 (74%)	60 (83%)	27 (59%)
> 9.5		31 (26%)	12 (17%)	19 (41%)
Creatinine (μmol/L)	127	85 (72–114)	82 (71–101)	95 (76–134)	0.040
≤ 104		88 (69%)	63 (79%)	25 (53%)
> 104		39 (31%)	17 (21%)	22 (47%)
AST (IU/L)	81	49 (29–83)	38 (25–66)	64 (42–99)	0.007
≤ 40		34 (42%)	27 (54%)	7 (23%)
> 40		47 (58%)	23 (46%)	24 (77%)
ALT (IU/L)	82	35 (22–65)	40 (22–67)	33 (22–54)	0.57
≤ 41		46 (56%)	25 (50%)	21 (66%)
> 41		36 (44%)	25 (50%)	11 (34%)

Notes: ^aMedian (IQR) or frequency (%) ^bWilcoxon rank sum test; Fisher’s exact test; Pearson’s Chi-squared test.

Abbreviations: ANC, absolute neutrophil count; ALC, absolute lymphocyte count; CRP, C-reactive protein; LDH, lactate dehydrogenase; INR, international normalized ratio; BUN, blood urea nitrogen; AST, aspartate aminotransferase; ALT, alanine aminotransferase; <, less than; >, more than.

Table 5 Factors Associated with Increased Odds of Mortality Among Patients Suffering with COVID-19

Variable	Univariable Analysis			Multivariable Analysis
	OR	95% CI	P-value	OR	95% CI	P-value
Age (years)	1.05	1.02–1.08	<0.001	1.07	1.03–1.11	0.001
Diabetes mellitus
No	Ref
Yes	2.11	1.05–4.28	0.037
Hypertension
No	Ref
Yes	2.87	1.39–5.96	0.004
Diabetes mellitus & hypertension
No	Ref
Yes	4.07	1.84–9.23	<0.001	1.71	0.48–6.24	0.400
Comorbids
With	Ref
Without	0.07	0.02–0.20	<0.001
BMI
Healthy weight	Ref
Overweight & obese	7.14	2.78–22.2	<0.001	9.44	2.71–41.0	0.001
Severity
Non severe	Ref
Severe	12.7	4.32–54.7	<0.001	4.77	1.18–25.0	0.039
Admitting ward
Isolation ward	Ref
CCU (HDU & ICU)	9.94	4.68–22.2	<0.001	6.68	2.06–24.6	0.002
Initial oxygen support
No	Ref
Yes	21.1	6.09–133.0	<0.001
D-dimer > 1 mg/L	1.34	1.13–1.59	<0.001