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Kanat BB, Avci GU, Bayramlar OF, Suzan V, Can G, Balkan II, Borekci S, Korkmazer B, Dikmen Y, Aygun G, Erdincler DS, Yavuzer H, Doventas A. Predictors of 2-year mortality in geriatric patients hospitalized with COVID-19 in Türkiye: a retrospective cohort study. Biomark Med 2024; 18:555-565. [PMID: 39140394 PMCID: PMC11364071 DOI: 10.1080/17520363.2024.2352416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/22/2024] [Indexed: 08/15/2024] Open
Abstract
Aim: To reveal factors affecting 2-year mortality in geriatric patients hospitalized with COVID-19.Methods: Demographic characteristics, clinical and laboratory data, thorax computed tomography (CT) images, second-year survival status, and causes of death were analyzed.Results: The 2-year post-discharge mortality rate of 605 patients was 21.9%. Mean age of patients in the deceased group was 76.8 ± 8.1 years, which was shorter than the life expectancy at birth in Türkiye. Older age (≥85), delirium, some co-morbidities, and atypical thorax CT involvement were associated with a significant increase in 2-year mortality (p < 0.05).Conclusion: This is the first study to evaluate factors associated with 2-year mortality in older COVID-19 patients. Identifying risk factors for long-term mortality in geriatric COVID-19 patients is important.
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Affiliation(s)
- Bahar Bektan Kanat
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Istanbul, Turkey
| | - Gulru Ulugerger Avci
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Istanbul, Turkey
| | - Osman Faruk Bayramlar
- Bakırkoy District Health Directorate, Turkish Ministry of Health – Istanbul Health Directorate, Istanbul, Turkey
| | - Veysel Suzan
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Istanbul, Turkey
| | - Gunay Can
- Department of Public Health, Cerrahpasa Medical Faculty, İstanbul University, Cerrahpaşa, İstanbul, Turkey
| | - Ilker Inanc Balkan
- Department of Infectious Diseases, Cerrahpasa Medical Faculty, İstanbul University, Cerrahpaşa, İstanbul, Turkey
| | - Sermin Borekci
- Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, İstanbul University, Cerrahpaşa, İstanbul, Turkey
| | - Bora Korkmazer
- Department of Radiology, Cerrahpasa Medical Faculty, İstanbul University, Cerrahpaşa, İstanbul, Turkey
| | - Yalim Dikmen
- Department of Anesthesiology & Reanimation, Cerrahpasa Medical Faculty, İstanbul University, Cerrahpaşa, İstanbul, Turkey
| | - Gokhan Aygun
- Department of Medical Microbiology, Cerrahpasa Medical Faculty, İstanbul University, Cerrahpaşa, İstanbul, Turkey
| | - Deniz Suna Erdincler
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Istanbul, Turkey
| | - Hakan Yavuzer
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Istanbul, Turkey
| | - Alper Doventas
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Istanbul, Turkey
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Wondmeneh TG, Mohammed JA. COVID-19 mortality rate and its determinants in Ethiopia: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1327746. [PMID: 38476444 PMCID: PMC10928001 DOI: 10.3389/fmed.2024.1327746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/12/2024] [Indexed: 03/14/2024] Open
Abstract
Background The COVID-19 mortality rate continues to be high in low-income countries like Ethiopia as the new variant's transmission expands and the countries' limited capacity to combat the disease causes severe outcomes, including deaths. The aim of this study is to determine the magnitude of the COVID-19 mortality rate and its determinants in Ethiopia. Methods The main electronic databases searched were PubMed, CINAHL, Google Scholar, and African journals online. The included studies' qualities were assessed independently using the Newcastle-Ottawa scale. The data was extracted in Microsoft Excel spreadsheet format. The pooled effect size and odds ratios with 95% confidence intervals across studies were determined using the random-effects model. I2 is used to estimate the percentage of overall variation across studies due to heterogeneity. Egger's test and funnel plot were used to find the published bias. A subgroup analysis was conducted. The effect of a single study on the overall estimation was determined by sensitivity analysis. Results A total of 21 studies with 42,307 study participants were included in the final analysis. The pooled prevalence of COVID-19 mortality was 14.44% (95% CI: 10.35-19.08%), with high significant heterogeneity (I2 = 98.92%, p < 0.001). The risk of mortality from COVID-19 disease was higher for patients with comorbidity (AHR = 1.84, 95% CI: 1.13-2.54) and cardiovascular disease (AHR = 2, 95% CI: 1.09-2.99) than their counterparts without these conditions. Conclusion A significant number of COVID-19 patients died in Ethiopia. COVID-19 patients with comorbidities, particularly those with cardiovascular disease, should receive special attention to reduce COVID-19 mortality. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, registration identifier (ID) CRD42020165740.
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Birhanu MY, Jemberie SS. Mortality rate and predictors of COVID-19 inpatients in Ethiopia: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1213077. [PMID: 37928474 PMCID: PMC10624109 DOI: 10.3389/fmed.2023.1213077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/31/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an extremely rare virus that devastates the economy and claims human lives. Despite countries' urgent and tenacious public health responses to the COVID-19 pandemic, the disease is killing a large number of people. The results of prior studies have not been used by policymakers and programmers due to the presence of conflicting results. As a result, this study was conducted to fill the knowledge gap and develop a research agenda. Objective This study aimed to assess the mortality rate and predictors of COVID-19 hospitalized patients in Ethiopia. Methods Electronic databases were searched to find articles that were conducted using a retrospective cohort study design and published in English up to 2022. The data were extracted using a Microsoft Excel spreadsheet and exported to StataTM version 17.0 for further analysis. The presence of heterogeneity was assessed and presented using a forest plot. The subgroup analysis, meta-regression, and publication bias were computed to identify the source of heterogeneity. The pool COVID-19 mortality rate and its predictors were calculated and identified using the random effects meta-analysis model, respectively. The significant predictors identified were reported using a relative risk ratio and 95% confidence interval (CI). Results Seven studies with 31,498 participants were included. The pooled mortality rate of COVID-19 was 9.13 (95% CI: 5.38, 12.88) per 1,000 person-days of mortality-free observation. Those study participants who had chronic kidney disease had 2.29 (95% CI: 1.14, 4.60) times higher chance of experiencing mortality than their corresponding counterparts, diabetics had 2.14 (95% CI: 1.22, 3.76), HIV patients had 2.98 (95% CI: 1.26, 7.03), hypertensive patients had 1.63 (95% CI: 1.43, 1.85), and smoker had 2.35 (95% CI: 1.48, 3.73). Conclusion COVID-19 mortality rate was high to tackle the epidemic of the disease in Ethiopia. COVID-19 patients with chronic renal disease, diabetes, hypertension, smoking, and HIV were the significant predictors of mortality among COVID-19 patients in Ethiopia. COVID-19 patients with chronic diseases and comorbidities need special attention, close follow-up, and care from all stakeholders.
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Affiliation(s)
- Molla Yigzaw Birhanu
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Selamawit Shita Jemberie
- Department of Midwifery, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Mastaneh Z, Mouseli A, Mohseni S, Dadipoor S. Predictors of hospital length of stay and mortality among COVID-19 inpatients during 2020-2021 in Hormozgan Province of Iran: A retrospective cohort study. Health Sci Rep 2023; 6:e1329. [PMID: 37324249 PMCID: PMC10265171 DOI: 10.1002/hsr2.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023] Open
Abstract
Background and Aims About one-fifth of patients with COVID-19 need to be hospitalized. Predicting factors affecting the hospital length of stay (LOS) can be effective in prioritizing patients, planning for services, and preventing the increase in LOS and death of patients. The present study aimed to identify the factors that predict LOS and mortality in COVID-19 patients in a retrospective cohort study. Methods A total of 27,859 patients were admitted to 22 hospitals from February 20, 2020 to June 21, 2021. The data collected from 12,454 patients were screened according to the inclusion and exclusion criteria. The data were captured from the MCMC (Medical Care Monitoring Center) database. The study tracked patients until their hospital discharge or death. Hospital LOS and mortality were assessed as the study outcomes. Results As the results revealed, 50.8% of patients were male and 49.2% were female. The mean hospital LOS of the discharged patients was 4.94. Yet, 9.1% of the patients (n = 1133) died. Among the predictors of mortality and long hospital LOS were the age above 60, admission to the ICU, coughs, respiratory distress, intubation, oxygen level less than 93%, cigarette and drug abuse, and a history of chronic diseases. Masculinity, gastrointestinal symptoms, and cancer were the effective variables in mortality, and positive CT was a factor significantly affecting the hospital LOS. Conclusion Paying special attention to high-risk patients and modifiable risk factors such as heart disease, liver disease, and other chronic diseases can diminish the complications and mortality rate of COVID-19. Providing training, especially for those who care for patients experiencing respiratory distress such as nurses and operating room personnel can improve the qualifications and skills of medical staff. Also, ensuring the availability of sufficient supply of medical equipment is strongly recommended.
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Affiliation(s)
- Zahra Mastaneh
- Department of Health Information Management and Technology, School of Allied Medical Sciences, Infectious and Tropical Diseases Research CenterHormozgan University of Medical SciencesBandar AbbasIran
| | - Ali Mouseli
- Department of Public Health, School of Health, Social Determinants in Health Promotion Research Center, Hormozgan Health InstituteHormozgan University of Medical SciencesBandar AbbasIran
| | - Shokrollah Mohseni
- Department of Public Health, School of Health, Social Determinants in Health Promotion Research Center, Hormozgan Health InstituteHormozgan University of Medical SciencesBandar AbbasIran
| | - Sara Dadipoor
- Department of Public Health, School of Health, Social Determinants in Health Promotion Research Center, Hormozgan Health InstituteHormozgan University of Medical SciencesBandar AbbasIran
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Dessie AM, Animut Z, Genet A, Yenew C. Incidence of Death and Its Predictors of COVID-19 in Amhara Region, Ethiopia: A Retrospective Follow Up Study. Infect Drug Resist 2022; 15:4907-4913. [PMID: 36060235 PMCID: PMC9432381 DOI: 10.2147/idr.s380591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Risk factors associated with COVID-19 incidence of death would aid to notify the most favorable management strategies, hang about undecided, Moreover, studies regarding this issue are limited in Ethiopia and no region-wise study is conducted. Hence, the study investigated the COVID-19 incidence of death and its predictors in the Amhara regional state, Ethiopia. Methods A facility-based retrospective survey was conducted at all Amhara regional state COVID-19 treatment centers from 13 March 2020, through 13 January 2022. Epidata version 3.1 and STATA version 14 were used for data entry and analysis, respectively. Linearized survey analysis in a stratified Cox regression model was fitted to identify independent risk factors. P-value with 95% CI for hazard ratio was used for testing the significance at alpha 0.05. Results A total of 28,533 study participants were analyzed in this study. Of these, 2873 (11.2%) died and 25,660 (88.8%) were recovered from COVID-19. The death rate was 11.78 per 1000 person-days of observation with a median survival time of 32 days with IQR [12, 44]. Patients with co-morbidities (AHR = 1.54: 95% CI: 1.51–1.55), patients with age <5-year (AHR = 1.69: 95% CI: 1.78–1.81) and patients with age 60+ years (AHR = 2.91: 95% CI: 1.79–3.99), patients with asymptomatic diseases condition (AHR =1.15: 95% CI: 1.01–1.19), and being male (AHR = 1.22: 95% CI: 1.18–1.27) were independent significant risk factors of death from COVID-19. Conclusion A relatively high incidence of death from COVID-19 was found in this study. Significant risk factors were identified as patients with age <5 years, patients with age 60+ Years, being male, patients having at least one comorbid condition, and patients with asymptomatic disease conditions. These factors should be taken into consideration for a strategy of quarantining and treating COVID-19 patients.
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Affiliation(s)
- Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Zelalem Animut
- Department of Public Health, Fahoba Health and Business College, Debre Markos, Ethiopia
| | - Almaw Genet
- Department of Public Health, College of Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Chalachew Yenew
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Correspondence: Chalachew Yenew, Tel +251945563008, Email
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Girma D, Dejene H, Adugna L, Tesema M, Awol M. COVID-19 Case Fatality Rate and Factors Contributing to Mortality in Ethiopia: A Systematic Review of Current Evidence. Infect Drug Resist 2022; 15:3491-3501. [PMID: 35813083 PMCID: PMC9270043 DOI: 10.2147/idr.s369266] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background The ongoing novel coronavirus disease 2019 (COVID-19) is triggering significant morbidity and mortality due to its contagious nature and absence of definitive management. In Ethiopia, despite a number of primary studies have been conducted to estimate the case fatality rate (CFR) of COVID-19, no review study has attempted to summarize the findings to better understand the nature of pandemics and the virulence of the disease. Objective To summarize the CFR of COVID-19 and factors contributing to mortality in Ethiopia. Methods PRISMA guideline was followed. PubMed, Science Direct, CINAHL, SCOPUS, Hinari, and Google Scholar were systematically searched using pre-specified keywords. Observational studies ie, cohort, cross-sectional, and case-control studies were included. The Newcastle-Ottawa scale adapted for observational studies was used to assess the quality of included studies. CFR was defined as the proportion of COVID-19 cases with the outcome of death within a given period. Factors contributing to COVID-19 mortality at p-value <0.05 were described narratively from the eligible articles. Results A total of 13 observational studies were included in this study. Consequently, this review confirmed the CFR of COVID-19 in Ethiopia ranges between 1–20%. Additionally, comorbid conditions, older age group, male sex, substance use, clinical manifestations (abnormal oxygen saturation level, atypical lymphocyte count, fever, and shortness of breath), disease severity, and history of surgery/trauma increased the likelihood of death from COVID-19 death. Conclusion This study shows that the range of CFR of COVID-19 in Ethiopia is almost equivalent to other countries, despite the country’s low testing capacity and case detection rate in reference to its total population. Comorbid diseases, older age group, male sex, cigarette smoking, alcohol drinking, clinical manifestations and disease severity, and history of surgery/trauma were factors contributing to COVID-19 mortality in Ethiopia. Therefore, given the alarming global situation and rapidly evolving large-scale pandemics, urgent interdisciplinary interventions should be implemented in those vulnerable groups to lessen the risk of mortality. Furthermore, the CFR of COVID-19 should be estimated from all treatment and rehabilitation centers in the country, as underestimation could be linked to a lack of preparedness and mitigation. A large set of prospective studies are also compulsory to better understand the CFR of COVID-19 in Ethiopia.
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Affiliation(s)
- Derara Girma
- Public Health Department, College of Health Sciences, Salale University, Fitche, Ethiopia
- Correspondence: Derara Girma, Email
| | - Hiwot Dejene
- Public Health Department, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Leta Adugna
- Public Health Department, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Mengistu Tesema
- Public Health Department, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Mukemil Awol
- Department of Midwifery, College of Health Sciences, Salale University, Fiche, Ethiopia
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Lemma Tirore L, Abose Nadamo S, Tamrat Derilo H, Erkalo D, Sedore T, Tadesse T, Ermias D, Yaekob T. Time to Recovery from Covid-19 and Its Predictors Among Patients Admitted to Treatment Centers of Southern Nations Nationalities and Peoples Region (SNNPR), ETHIOPIA: Multi-Center Retrospective Cohort Study. Infect Drug Resist 2022; 15:3047-3062. [PMID: 35747331 PMCID: PMC9209334 DOI: 10.2147/idr.s365986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/10/2022] [Indexed: 01/08/2023] Open
Abstract
Background The world is currently facing a pandemic of Coronavirus Disease 2019 (Covid-19). It has caused significant morbidity and mortality. So far little is known about recovery time (prolonged hospital stay) from Covid-19 and its determinants in Ethiopia as well as in the study area. Therefore, the aim of this study was to determine time to recovery from Covid-19, and identify predictors of time to recovery among patients admitted to treatment centers of Southern Nations Nationalities and Peoples Region (SNNPR). Methods and Materials A facility-based retrospective cohort study was conducted among Covid-19 patients admitted to care centers of SNNPR from May 30, 2020 to October 15, 2021. A sample of 845 patients was included in the study. Summarization of the data was done using mean (standard deviation) and median (inter quartile range). Kaplan-Meier Survival Curve was used to estimate recovery time from Covid-19 and the independent effects of covariates on recovery time was analyzed using multivariable Cox-proportional hazard model. Results The incidence density of recovery was 8.24 per 100 person-days (95% CI: 7.67, 8.85). The overall median recovery time was 10 days (IQR: 8-16 days). Critical stage of Covid-19 (aHR = 0.19, 95% CI: 0.12, 0.29), severe stage of Covid-19 (aHR = 0.40, 95% CI: 0.29, 0.56), mechanical ventilation (aHR = 0.20, 95% CI: 0.073, 0.56) and treatment center (aHR = 0.68, 95% CI: 0.51, 0.90) were significant predictors of recovery rate among Covid-19 patients. Conclusion The median time to recovery from Covid-19 was relatively short. The incidence density of recovery was 8.24 per 100 person-days. The hazard of recovery was lower for patients at higher levels of Covid-19 severity and for patients in need of mechanical ventilation. Early identification of severity levels of the patients is required at the time of admission. Special attention, critical follow-up and management is warranted for patients at higher levels of Covid-19 severity.
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Affiliation(s)
| | | | | | - Desta Erkalo
- Department of Public Health, Wachemo University, Hossana, Ethiopia
| | - Tagesse Sedore
- Department of Public Health, Wachemo University, Hossana, Ethiopia
| | - Tegegn Tadesse
- Department of Public Health, Wachemo University, Hossana, Ethiopia
| | - Dejene Ermias
- Department of Public Health, Wachemo University, Hossana, Ethiopia
| | - Temesgen Yaekob
- Department of Statistics, Wachemo University, Hossana, Ethiopia
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Birhanu A, Ayana GM, Merga BT, Alemu A, Negash B, Seid A, Dessie Y. Incidence and predictors of organ failure among COVID-19 hospitalized adult patients in Eastern Ethiopia. Hospital-based retrospective cohort study. BMC Infect Dis 2022; 22:412. [PMID: 35484484 PMCID: PMC9048613 DOI: 10.1186/s12879-022-07402-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 04/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background Organ failure is incapability of at least one of the body organs to carry out a normal body functions. Identifying the predictors of the organ failure is crucial for improving COVID-19 patients’ survival. However, the evidence related to this information is not well-established in developing countries, including Ethiopia. Therefore, this study aimed to determine the incidence and predictors of organ failure among adult patients admitted to Hiwot Fana Specialized University Hospital (HFSUH) COVID-19 treatment center from 1st May 2020 to 20th August 2021, Eastern Ethiopia. Methods A hospital-based retrospective cohort study design was implemented. Descriptive measures such as mean with standard deviation (SD), median with interquartile range (IQR), percentages, and frequencies were computed. The binary logistic regression was used to identify the association between outcome variables (organ functional status) and independent variables with an adjusted odds ratio (AOR) at a 95% confidence interval. A significance level was declared at a p-value of less than 0.05. Results The mean age of study participants was 47.69 years with the standard deviation (SD) of ± 17.03. The study participants were followed for the median time of 8 days with IQR of 4, 14. The incidence of organ failure was 11.9 per 1000 person-day contribution (95% CI: 9.5, 14.9). Predictors such as age above 60 years (AOR = 1.71, 95% CI: 1.44, 4.53), smoking history (AOR = 5.07, 95% CI: 1.39, 8.15), cardiovascular disease (AOR = 5.00, 95% CI: (1.83, 11.72), and critical clinical stages of COVID-19 (AOR = 5.42, 95%: 1.47, 14. 84) were significantly associated with organ failure among COVID-19 hospitalized patients. Conclusions The incidence of organ failure was 11.9 per 1000 person-day contribution. Age, smoking, comorbidity, and clinical stages were significantly associated with organ failure among COVID-19 hospitalized cases. Therefore, clinicians should stringently follow the patients experiencing modifiable predictors of organ failure, especially patients with comorbidities and severe clinical stages. Moreover, the prevention programs that target elders and smokers should be strengthening to save this segment of populations before suffering from organ failure following COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07402-6.
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Affiliation(s)
- Abdi Birhanu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Galana Mamo Ayana
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bedasa Taye Merga
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Alemu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Belay Negash
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ahmed Seid
- Hiwot Fana Specialized University Hospital, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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