Mortality rate and predictors of COVID-19 inpatients in Ethiopia: a systematic review and meta-analysis

Predictors of Hospitalization for Patients Presenting to Emergency Department with COVID-19 Infection

Background: Predictors of morbidity and mortality in hospitalized COVID-19 patients have been extensively studied. However, comparative analyses of predictors for hospitalization versus discharge from the emergency department remain limited. Methods: This retrospective study evaluated predictors of hospitalization among adults (≥18 years) presenting to the emergency department with COVID-19 infection between 1 March 2020 and 15 June 2020. Data were obtained from electronic health records across five hospitals within the Johns Hopkins Health System, encompassing 2513 beds. Multivariable logistic regression models were employed to assess the association between sociodemographic characteristics, clinical symptoms, and comorbidities with hospitalization. Results: Of the 2767 patients presenting to the emergency department, 1678 (61%) were hospitalized, while 1089 (39%) were discharged from the emergency department. Hospitalized patients were older (mean age 61.8 years, SD 18), more likely to be African American and White, non-Hispanic, unemployed or on disability, medically insured, had access to primary care, and presented on weekends. Smoking status, alcohol use, and higher comorbidity burden (mean age-adjusted Charlson Comorbidity Index > 3) were also more prevalent with hospitalization. Dyspnea was a prominent clinical feature among hospitalized patients. After adjusting for sociodemographic and clinical risk factors, significant predictors of hospitalization included health insurance (OR 3.44; 95% CI: 1.98-6), having a primary care (OR 1.85; 95% CI: 1.33-2.59), presentation from a non-home locale (OR 4.04; 95% CI: 1.93-8.47), age-adjusted CCI > 3 (OR 1.72; 95% CI: 1.11-2.68), dyspnea (OR 2.22; 95% CI: 1.56-3.17), neutrophil-to-lymphocyte ratio ≥ 3 (OR 2.17; 95% CI: 1.54-3.06), and an abnormal chest radiograph findings (OR 6.17; 95% CI: 4.40-8.66). Interestingly, obesity, defined as a BMI ≥ 30 kg/m2 (OR 0.45; 95% CI: 0.32-0.64), and the presence of fever (OR 0.64; 95% CI: 0.43-0.95) were found to be associated with a decreased likelihood of hospitalization. Conclusions: Future studies are warranted to further explore predictors of COVID-19 hospitalization, with particular focus on the implications of weekend presentations and the paradoxical relationship of obesity with COVID-19 health outcomes. These findings could inform the development of triage models to enhance preparedness for future pandemics.

Protecting effects of smoking against COVID-19: a community-based retrospective cohort study in middle- and older-aged adults

On December 7, 2022, China switched from dynamic zeroing strategy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to reopening. A nationwide SARS-CoV-2 epidemic emerged rapidly. The effect of smoking on SARS-CoV-2 infection remains unclear. We aimed to retrospectively investigate the relationship between smoking and coronavirus disease 2019 (COVID-19) using a community-based cohort of smokers and non-smokers. We included participants from a pre-pandemic cohort with a prolonged follow-up period. Data on smoking status, body mass index, and history of other diseases were collected from health examination and consultation clinic records. Cox regression analysis was used to identify the relationship between groups and SARS-CoV-2 infection over time. We analysed 218 male patients with varied smoking statuses (46.3% current or ex-smokers; average age 68.63 ± 9.81 years). Two peaks in the epidemic were observed following the December 2022 outbreak. At the end of the second peak, non-smokers, current smokers, and ex-smokers had primary infection rates increase to 88.0%, 65.1%, and 81.0%, respectively, with a significant difference between the groups. Current smoking significantly protected against SARS-CoV-2 infection (HR 0.625, 95% CI 0.402-0.970, p = 0.036). Further analyses showed that the prevalence of pneumonia in the unvaccinated, older, diabetic, and non-smoking groups was significantly higher than that in the other groups (p < 0.05). Our study suggests a potential association between smoking and a reduced risk of SARS-CoV-2 infection and pneumonia. This indicates that nicotine and ACE2 play important roles in preventing COVID-19 and its progression. We suggest smokers use nicotine replacement therapy during hospitalization for COVID-19.

COVID-19 mortality rate and its determinants in Ethiopia: a systematic review and meta-analysis

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.