Factors associated with adverse outcomes among patients hospitalized at a COVID-19 treatment center in Herat, Afghanistan

Abstract

Though many studies on COVID have been published to date, data on COVID-19 epidemiology, symptoms, risk factors and severity in low- and middle-income countries (LMICS), such as Afghanistan are sparse. To describe clinical characteristics, severity, and outcomes of patients hospitalized in the MSF COVID-19 treatment center (CTC) in Herat, Afghanistan and to assess risk factors associated with severe outcomes. 1113 patients were included in this observational study between June 2020 and April 2022. Descriptive analysis was performed on clinical characteristics, complications, and outcomes of patients. Univariate description by Cox regression to identify risk factors for an adverse outcome was performed. Adverse outcome was defined as death or transfer to a level 3 intensive care located at another health facility. Finally, factors identified were included in a multivariate Cox survival analysis. A total of 165 patients (14.8%) suffered from a severe disease course, with a median time of 6 days (interquartile range: 2-11 days) from admission to adverse outcome. In our multivariate model, we identified male gender, age over 50, high O2 flow administered during admission, lymphopenia, anemia and O2 saturation < = 93% during the first three days of admission as predictors for a severe disease course (p<0.05). Our analysis concluded in a relatively low rate of adverse outcomes of 14.8%. This is possibly related to the fact that the resources at an MSF-led facility are higher, in terms of human resources as well as supply of drugs and biomedical equipment, including oxygen therapy devices, compared to local hospitals. Predictors for severe disease outcomes were found to be comparable to other settings.

Fig 1. Weekly admissions stratified by outcome.

Number of patients admitted to the CTC per week stratified by outcome. As can be seen in the graph, the CTC remained open between waves 3 and 4.

Fig 2. Most common symptoms of patients at admission stratified by wave.

Fig 3. Evolution of patients’ vital signs over the first ten days after admission.

A: O2 Saturation over time; B: Systolic blood pressure over time; C: Diastolic blood pressure over time. All graphs include median values, IQR and a linear trendline. Values for patients with a positive outcome are shown in blue, orange stands for patients with an adverse outcome. Abbreviations: bp: blood pressure.