Patient characteristics and risk factors contributing to mortality among hospitalised patients with COVID-19 in Malaysia
Main Article Content
Keywords
COVID-19, mortality, risk factors, characteristics, Malaysia
Abstract
Background: The COVID-19 pandemic caused a significant increase in deaths globally. However, there is a scarcity of data addressing risk factors associated with mortality among hospitalised COVID-19 patients in Malaysia. This study aimed to identify the predictors of death among hospitalised COVID-19 patients in Malaysia. Methods: A retrospective cross-sectional study was conducted at two public hospitals in East Coast Malaysia from February 2020 to August 2021. The study included all hospitalised COVID-19 patients by extracting data from the electronic medical records focusing on patient demographics and clinical outcomes. Univariable and multivariable logistic regression analyses were conducted to evaluate association between risk factors and mortality among COVID-19 patients. Results: A total of 1060 patients were included (59% male) with median age of 41.5 years (IQR 27 – 58.5). Multivariable logistic regression showed that factors contributing to mortality of COVID-19 patients were elderly (OR, 1.04; 95% CI, 1.02, 1.06; p = 0.001), chronic kidney disease (OR, 3.75; 95% CI, 1.25, 11.27; p = 0.019), an increased point of CCI score (OR, 1.59; 95% CI, 1.25, 2.05; p = ≤0.05), progression to severe stage (OR, 40.68; 95% CI, 17.55, 94.31; p = ≤ 0.05) and admitted to intensive care unit (ICU) (OR, 2.68; 95% CI, 1.16, 6.17, p = 0.021). Conclusion: Patients who were elderly, with chronic kidney disease, multiple comorbidities, progressed to severe stage and admitted to ICU were at significantly increased risk of mortality. These findings highlight the importance of implementing extra monitoring and aggressive preventive measures for high-risk patients, in order to reduce their mortality risk and improve patient outcomes.
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43. Fouad SH, Allam MF, Ibrahim S, et al. ICU admission of COVID-19 patients: Identification of risk factors. Egyptian Journal of Anaesthesia. 2021;37(1):202-207. https://dx.doi.org/10.1080/11101849.2021.1919433
44. Perrotta F, Corbi G, Mazzeo G. COVID-19 and the elderly: insights into pathogenesis and clinical decision-making. Aging Clinical and Experimental Research. 2020;32(8):1599-1608. https://doi.org/10.1007/s40520-020-01631-y
2. Biancolella M, Colona VL, Mehrian-Shai R, et al. COVID-19 2022 update: transition of the pandemic to the endemic phase. Human Genomics. 2022;16:19. https://doi.org/10.1186/s40246-022-00392-1
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jama.2020.1585
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2020;180(7):934-943. https://doi.org/10.1001/jamainternmed.2020.0994
9. Talukder A, Razu SR, Alif SM, et al. Association between symptoms and severity of disease in hospitalised novel coronavirus (COVID-19) patients: a systematic review and meta-analysis. Journal of Multidisciplinary Healthcare. 2022;15:1101-1110.
https://doi.org/10.2147/JMDH.S357867
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12. Sharif N, Opu RR, Ahmed SN, et al. Prevalence and impact of comorbidities on disease prognosis among patients with COVID-19 in Bangladesh: a nationwide study amid the second wave. Diabetes & Metabolic Syndrome: Clinical Research & Reviews.
2021;15(4):102148. https://doi.org/10.1016/j.dsx.2021.05.021
13. Shi L, Wang Y, Wang Y, et al. Dyspnea rather fever is a risk factor for predicting mortality in patients with COVID-19. Journal of Infection. 2020;81(4):647-679. https://doi.org/10.1016%2Fj.jinf.2020.05.013
14. Shenoy N, Luchtel R, Gulani P. Considerations for target oxygen saturation in COVID-19 patients: are we under-shooting? BMC Medicine. 2020;18(1):260. https://doi.org/10.1186%2Fs12916-020-01735-2
15. Statistics on cause of death, Malaysia. Department of Statistics Malaysia; [cited 2022 Dec7]. Retrieved from https://www.dosm.gov.my/v1/index.php?r=column/cthemeByCat&cat=401&bul_id=QkxLckg3WjlzcEZyVzRIajllenBIQT09&menu_
id=L0pheU43NWJwRWVSZklWdzQ4TlhUUT09
16. Lim PY, Said SM, Shahar HK, et al. COVID-19 inpatient deaths and brought-in-dead cases in Malaysia. Front Public Health. 2022;10:872838. https://doi.org/10.3389/fpubh.2022.872838
17. Zhou W, Liu Y, Xu B, et al. Early identification of patients with severe COVID-19 at increased risk of in-hospital death: a multicenter case-control study in Wuhan. Journal of Thoracic Disease. 2021;13(3):1380-1395. https://doi.org/10.21037%2Fjtd-20-2568
18. Kadam P, Bhalerao S. Sample size calculation. International Journal of Ayurveda Research. 2010;1(1):55-57. https://doi.org/10.4103/0974-7788.59946
19. Daniel WW. Biostatistics: A foundation for analysis in the health sciences. John Wiley & Sons, Inc. 2005.
20. COVIDNOW in Malaysia. Ministry of Health Malaysia; [cited 2022 Aug21]. Retrieved from https://covidnow.moh.gov.my/
21. Charlson ME, Carrozzino D, Guidi J, et al. Charlson comorbidity index: A critical review of clinimetric properties. Psychother Psychosom. 2022;9(1):8-35. https://doi.org/10.1159/000521288
22. Ministry of Health Malaysia. Annex 2e: Clinical management of confirmed COVID-19 case in adult and paediatric. 2020. Retrieved from http://covid-19.moh.gov.my/garis-panduan/garis-panduan-kkm/Annex_2e_Clinical_Management_For_
Confirmed_COVID-19_in_Adult_and_Paed.28.09.20.pdf
23. Bono R, Blanca MJ, Arnau J, et al. Non-normal distributions commonly used in health, education, and social sciences: A systematic review. Frontiers in Psychology. 2017;8:1602. https://doi.org/10.3389/fpsyg.2017.01602
24. Marcoulides KM, Raykov T. Evaluation of variance inflation factors in regression models using latent variable modeling methods. Education and Psychological Measurement. 2019;79(5):874-882. https://doi.org/10.1177/0013164418817803
25. Andrade C. The P value and statistical significance: misunderstandings, explanations, challenges, and alternatives. Indian Journal of Psychological Medicine. 2019;41(3):210-215. https://dx.doi.org/10.4103%2FIJPSYM.IJPSYM_193_19
26. Hosmer DW, Lemeshow S. Applied logistic regression. John Wiley & Sons, Inc. 2000. https://dx.doi.org/10.1002/0471722146
27. Vaccinations in Malaysia. Ministry of Health Malaysia; [cited 2022 Dec13]. Retrieved from https://covidnow.moh.gov.my/vaccinations
28. Parohan M, Yaghoubi A, Seraji A, et al. Risk factors for mortality in patients with Coronavirus disease 2019 (COVID-19) infection:a systemic review and meta-analysis of observational studies. Taylor & Francis Group. 2020;23(5):1416-1424. https://doi.or
g/10.1080/13685538.2020.1774748
29. Hobbs ALV, Turner N, Omer I, et al. Risk factors for mortality and progression to severe COVID-19 disease in the Southeast region in the United States: A report from SEUS Study group. Infection Control & Hospital Epidemiology. 2021;42(12):1464-
1472. https://dx.doi.org/10.1017/ice.2020.1435
30. Damayanthi H, Prabani K, Weerasekara I. Factors associated for mortality of older people with COVID-19: A systematic review and meta-analysis. Gerontology & Geriatric Medicine. 2021;7:23337214211057392. https://doi.org/10.1177/23337214211057392
31. Ponnappan S, Ponnappan U. Aging and immune function: molecular mechanisms to interventions. Antioxidants & Redox Signaling. 2011;14(8):1551-1585. https://doi.org/10.1089/ars.2010.3228
32. Awang H, Yaacob EL, Daud AA, et al. Risk factors for mortality among COVID-19 patients in Besut region, Terengganu, Malaysia. Journal of Medical and Health Sciences. 2022;4(3). http://dx.doi.org/10.24018/ejmed.2022.4.3.1307
33. Albitar O, Ballouze R, Ooi JP, et al. Risk factors for mortality among COVID-19 patients. Diabetes Research and Clinical Practice. 2020;166:108293. https://doi.org/10.1016/j.diabres.2020.108293
34. Danser AJ, Epstein M, Battle D. Renin-angiotensin system blockers and the COVID-19 pandemic. American Heart Association. 2020;75(6):1382-1385. https://doi.org/10.1161/HYPERTENSIONAHA.120.15082
35. Christiansen CF, Pottegard A, Heide-Jorgensen U, et al. SARS-CoV-2 infection and adverse outcomes in users of ACE inhibitors and angiotensin-receptor blockers: a nationwide case-control and cohort analysis. Thorax. 2021;76:370-379. https://dx.doi.
org/10.1136/thoraxjnl-2020-215768
36. Rastad H, Ejtahed H, Shafiee G, et al. The risk factors associated with COVID-19-related death among patients with end-stage renal disease. BMC Nephrology. 2021;22:33. https://doi.org/10.1186/s12882-020-02221-w
37. Menon T, Gandhi SAQ, Tariq W, et al. Impact of chronic kidney disease on severity and mortality in COVID-19 patients: a systematic review and meta-analysis. Cureus. 2021;13(4):e14279. https://doi.org/10.7759/cureus.14279
38. Soares RCM, Mattos LR, Raposo LM. Risk factors for hospitalization and mortality due to COVID-19 in Espirito Santo State, Brazil. The American Journal of Tropical Medicine and Hygiene. 2020;103(3):1184-1190. https://dx.doi.org/10.4269/ajtmh.20-0483
39. Gibertoni D, Reno C, Rucci P, et al. COVID-19 incidence and mortality in non-dialysis chronic kidney disease patients. PLoS ONE. 2021;16(7):e0254525. https://doi.org/10.1371/journal.pone.0254525
40. Kuswardhani RAT, Henrina H, Pranata R, et al. Charlson comorbidity index and a composite of poor outcomes in COVID-19
patients: A systematic review and meta-analysis. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 2020;2103-2109. https://doi.org/10.1016/j.dsx.2020.10.022
41. Abidin NHZ, Lee CK, Zakaria SA, et al. Clinical course and outcomes of ventilated critically ill COVID-19 patients in Selangor state, Malaysia. Journal of Emergency and Critical Care Medicine. 2021;5(6). https://dx.doi.org/10.21037/jeccm-20-82
42. Kim L, Garg S, O’Halloran A, et al. Risk factors for intensive care unit admission and in-hospital mortality among hospitalized adults identified through the US Coronavirus Disease 2019 (COVID-19) –associated hospitalization surveillance network
(COVID-NET). Clinical Infectious Disease. 2021;72(9):206-214. https://doi.org/10.1093/cid/ciaa1012
43. Fouad SH, Allam MF, Ibrahim S, et al. ICU admission of COVID-19 patients: Identification of risk factors. Egyptian Journal of Anaesthesia. 2021;37(1):202-207. https://dx.doi.org/10.1080/11101849.2021.1919433
44. Perrotta F, Corbi G, Mazzeo G. COVID-19 and the elderly: insights into pathogenesis and clinical decision-making. Aging Clinical and Experimental Research. 2020;32(8):1599-1608. https://doi.org/10.1007/s40520-020-01631-y
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Patient characteristics and risk factors contributing to mortality among hospitalised patients with COVID-19 in Malaysia. Pharm Pract (Granada) [Internet]. 2023 Sep. 27 [cited 2024 Oct. 4];21(3):1-8. Available from: https://pharmacypractice.org/index.php/pp/article/view/2857
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How to Cite
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Patient characteristics and risk factors contributing to mortality among hospitalised patients with COVID-19 in Malaysia. Pharm Pract (Granada) [Internet]. 2023 Sep. 27 [cited 2024 Oct. 4];21(3):1-8. Available from: https://pharmacypractice.org/index.php/pp/article/view/2857