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Observational Study
. 2022 Dec 30;17(12):e0279565.
doi: 10.1371/journal.pone.0279565. eCollection 2022.

Clinical characteristics associated with mortality of COVID-19 patients admitted to an intensive care unit of a tertiary hospital in South Africa

Peter S Nyasulu  1 , Birhanu T Ayele  1 , Coenraad F Koegelenberg  2 , Elvis Irusen  2 , Usha Lalla  2 , Razeen Davids  3 , Yazied Chothia  3 , Francois Retief  4 , Marianne Johnson  4 , Stephen Venter  4 , Renilda Pillay  4 , Hans Prozesky  5 , Jantjie Taljaard  5 , Arifa Parker  5 , Eric H Decloedt  6 , Portia Jordan  7 , Sa'ad Lahri  8 , M Rafique Moosa  9 , Muhammad Saadiq Moolla  9 , Anteneh Yalew  1 , Nicola Baines  1 , Padi Maud  2 , Elizabeth Louw  2 , Andre Nortje  2 , Rory Dunbar  10 , Lovemore N Sigwadhi  1 , Veranyuy D Ngah  1 , Jacques L Tamuzi  1 , Annalise Zemlin  11 , Zivanai Chapanduka  12 , René English  13 , Brian W Allwood  2
Affiliations
Observational Study

Clinical characteristics associated with mortality of COVID-19 patients admitted to an intensive care unit of a tertiary hospital in South Africa

Peter S Nyasulu et al. PLoS One. .

Abstract

Background: Over 130 million people have been diagnosed with Coronavirus disease 2019 (COVID-19), and more than one million fatalities have been reported worldwide. South Africa is unique in having a quadruple disease burden of type 2 diabetes, hypertension, human immunodeficiency virus (HIV) and tuberculosis, making COVID-19-related mortality of particular interest in the country. The aim of this study was to investigate the clinical characteristics and associated mortality of COVID-19 patients admitted to an intensive care unit (ICU) in a South African setting.

Methods and findings: We performed a prospective observational study of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to the ICU of a South African tertiary hospital in Cape Town. The mortality and discharge rates were the primary outcomes. Demographic, clinical and laboratory data were analysed, and multivariable robust Poisson regression model was used to identify risk factors for mortality. Furthermore, Cox proportional hazards regression model was performed to assess the association between time to death and the predictor variables. Factors associated with death (time to death) at p-value < 0.05 were considered statistically significant. Of the 402 patients admitted to the ICU, 250 (62%) died, and another 12 (3%) died in the hospital after being discharged from the ICU. The median age of the study population was 54.1 years (IQR: 46.0-61.6). The mortality rate among those who were intubated was significantly higher at 201/221 (91%). After adjusting for confounding, multivariable robust Poisson regression analysis revealed that age more than 48 years, requiring invasive mechanical ventilation, HIV status, procalcitonin (PCT), Troponin T, Aspartate Aminotransferase (AST), and a low pH on admission all significantly predicted mortality. Three main risk factors predictive of mortality were identified in the analysis using Cox regression Cox proportional hazards regression model. HIV positive status, myalgia, and intubated in the ICU were identified as independent prognostic factors.

Conclusions: In this study, the mortality rate in COVID-19 patients admitted to the ICU was high. Older age, the need for invasive mechanical ventilation, HIV status, and metabolic acidosis were found to be significant predictors of mortality in patients admitted to the ICU.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Distribution and outcome of COVID-19 patients admitted in the ICU.
Fig 2
Fig 2. Kaplan-Meier product limit estimates of survival among intubated and non-intubated COVID-19 patients admitted to ICU.
Fig 3
Fig 3. Log-log plot of survival of COVID-19 patients admitted to ICU to assess the assumption of proportional hazards.
See this image and copyright information in PMC

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