Epidemiological and clinical characteristics of patients hospitalised with COVID-19 in Kenya: a multicentre cohort study

  1. Loice Achieng Ombajo
  2. Nyamai Mutono
  3. Paul Sudi
  4. Mbuvi Mutua
  5. Mohammed Sood
  6. Alliyy Muhammad Loo
  7. Phoebe Juma
  8. Jackline Odhiambo
  9. Reena Shah
  10. Frederick Wangai
  11. Marybeth Maritim
  12. Omu Anzala
  13. Patrick Amoth
  14. Evans Kamuri
  15. Waweru Munyu
  16. S M Thumbi

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Abstract

To assess outcomes of patients admitted to hospital with COVID-19 and to determine the predictors of mortality.

Setting

This study was conducted in six facilities, which included both government and privately run secondary and tertiary level facilities in the central and coastal regions of Kenya.

Participants

We enrolled 787 reverse transcriptase-PCR-confirmed SARS-CoV2-infected persons. Patients whose records could not be accessed were excluded.

Primary and secondary outcome measures

The primary outcome was COVID-19-related death. We used Cox proportional hazards regressions to determine factors related to in-hospital mortality.

Results

Data from patients with 787 COVID-19 were available. The median age was 43 years (IQR 30–53), with 505 (64%) being men. At admission, 455 (58%) were symptomatic with an additional 63 (9%) developing clinical symptoms during hospitalisation. The most common symptoms were cough (337, 43%), loss of taste or smell (279, 35%) and fever (126, 16%). Comorbidities were reported in 340 (43%), with cardiovascular disease, diabetes and HIV documented in 130 (17%), 116 (15%), 53 (7%), respectively. 90 (11%) were admitted to the Intensive Care Unit (ICU) for a mean of 11 days, 52 (7%) were ventilated with a mean of 10 days, 107 (14%) died. The risk of death increased with age (HR 1.57 (95% CI 1.13 to 2.19)) for persons >60 years compared with those <60 years old; having comorbidities (HR 2.34 (1.68 to 3.25)) and among men (HR 1.76 (1.27 to 2.44)) compared with women. Elevated white cell count and aspartate aminotransferase were associated with higher risk of death.

Conclusions

The risk of death from COVID-19 is high among older patients, those with comorbidities and among men. Clinical parameters including patient clinical signs, haematology and liver function tests were associated with risk of death and may guide stratification of high-risk patients.

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  1. Version published to 10.1136/bmjopen-2021-049949
  2. ScreenIT

    SciScore for 10.1101/2020.11.09.20228106: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study received ethical approval from the Kenyatta National Hospital-University of Nairobi Ethics and Research Committee (approval number P223/03/2020).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations of this study include the absence of laboratory parameters for some of the study patients, pulse oximetry was not routinely recorded during the initial period of the outbreak and we did not have access to other laboratory markers that have been shown to predict mortality including D-dimers and interleukin 6.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.11.09.20228106 on medRxiv