Document Type : Original Article
Authors
- Ahmad Mohtashami 1
- Milad Ahmadi Gohari 2
- Abbas Bahrampour 1
- mohamadhossein mehrolhasani 3
- Yunes Jahani 1
1 Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
2 Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
3 Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of medical sciences, Kerman, Iran.
Abstract
Introduction: This study aims to identify the risk factors affecting mortality among Covid-19 patients in the southeast of Iran.
Methods: This cross-sectional study used data from the Covid-19 patients admitted to Afzalipur Teaching Hospital in Kerman, Iran, from February 2020 to September 2021. The demographic and clinical data of 6,057 patients were analyzed using Bayesian network and logistic regression models.
Findings: Out of 6,057 patients, 333 patients (5.5%) died. The most important risk factors for Covid-19 mortality were age, gender, fever, headache, decreased level of consciousness (LoC), chronic liver disease, blood oxygen level (BOL), admission season, and length of stay (LoS). Fever, headache, and longer LoS were protective and mortality-reducing variables.
Conclusion: Following model estimation results, it is recommended that old male patients with low oxygen levels and a lower LoC, as well as patients with chronic liver disease, receive additional medical care and not be discharged prematurely. Early medical interventions for high-risk patients may reduce the Covid-19 mortality risk.
Keywords
Main Subjects
- COVID-19 Coronavirus Pandemic. Worldometer; 2023.
- Nakhaeizadeh M, Eybpoosh S, Jahani Y, Ahmadi Gohari M, Haghdoost AA, White L, et al. Impact of non-pharmaceutical interventions on the control of COVID-19 in Iran: a mathematical modeling study. Int J Health Policy Manag. 2022;11(8):1472-81. doi: 10.34172/ijhpm.2021.48.
- Nakhaeizadeh M, Chegeni M, Adhami M, Sharifi H, Ahmadi Gohari M, Iranpour A, et al. Estimating the number of COVID-19 cases and impact of new COVID-19 variants and vaccination on the population in Kerman, Iran: a mathematical modeling study. Comput Math Methods Med. 2022;2022:6624471. doi: 10.1155/2022/6624471.
- Ahmadi Gohari M, Chegeni M, Haghdoost AA, Mirzaee F, White L, Kostoulas P, et al. Excess deaths during the COVID-19 pandemic in Iran. Infect Dis (Lond). 2022;54(12):909-17. doi: 10.1080/23744235.2022.2122554.
- Pfefferbaum B, North CS. Mental health and the COVID-19 pandemic. N Engl J Med. 2020;383(6):510-2. doi: 10.1056/ NEJMp2008017.
- Dong L, Bouey J. Public mental health crisis during COVID-19 pandemic, China. Emerg Infect Dis. 2020;26(7):1616-8. doi: 10.3201/eid2607.200407.
- de Cássia Menezes Soares R, Mattos LR, Raposo LM. Risk factors for hospitalization and mortality due to COVID-19 in Espírito Santo State, Brazil. Am J Trop Med Hyg. 2020;103(3):1184-90. doi: 10.4269/ajtmh.20-0483.
- Karasneh RA, Khassawneh BY, Al-Azzam S, Al-Mistarehi AH, Lattyak WJ, Aldiab M, et al. Risk factors associated with mortality in COVID-19 hospitalized patients: data from the Middle East. Int J Clin Pract. 2022;2022:9617319. doi: 10.1155/2022/9617319.
- Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584(7821):430-6. doi: 10.1038/s41586-020-2521-4.
- Ruíz-Quiñonez JA, Guzmán-Priego CG, Nolasco-Rosales GA, Tovilla-Zarate CA, Flores-Barrientos OI, Narváez-Osorio V, et al. Features of patients that died for COVID-19 in a hospital in the south of Mexico: a observational cohort study. PLoS One. 2021;16(2):e0245394. doi: 10.1371/journal.pone.0245394.
- Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-5. doi: 10.1016/j.ijid.2020.03.017.
- Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB, et al. COVID-19 patients’ clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020;92(6):577- 83. doi: 10.1002/jmv.25757.
- Brandt EB, Beck AF, Mersha TB. Air pollution, racial disparities, and COVID-19 mortality. J Allergy Clin Immunol. 2020;146(1):61-3. doi: 10.1016/j.jaci.2020.04.035.
- Conticini E, Frediani B, Caro D. Can atmospheric pollution be considered a co-factor in extremely high level of SARS-CoV-2
lethality in Northern Italy? Environ Pollut. 2020;261:114465. doi: 10.1016/j.envpol.2020.114465.
- Dutheil F, Baker JS, Navel V. COVID-19 as a factor influencing air pollution? Environ Pollut. 2020;263(Pt A):114466. doi: 10.1016/j.envpol.2020.114466.
- Tobías A, Molina T. Is temperature reducing the transmission of COVID-19? Environ Res. 2020;186:109553. doi: 10.1016/j. envres.2020.109553.
- Das A, Ghosh S, Das K, Basu T, Dutta I, Das M. Living environment matters: unravelling the spatial clustering of COVID-19 hotspots in Kolkata megacity, India. Sustain Cities Soc. 2021;65:102577. doi: 10.1016/j.scs.2020.102577.
- Sarkar A, Chouhan P. COVID-19: district level vulnerability assessment in India. Clin Epidemiol Glob Health. 2021;9:204- 15. doi: 10.1016/j.cegh.2020.08.017.
- Ahmadi A, Ardeshiri S, Rajab Nezhadi V, Pajoohesh A, Narimani Moghadam T, Sabaghan M, et al. Risk factors for mortality in hospitalized patients with COVID-19: a cross-sectional study in southwestern Iran. Iran Red Crescent Med J. 2021;23(9):e1230. doi: 10.32592/ircmj.2021.23.9.1230.
- Vepa A, Saleem A, Rakhshan K, Daneshkhah A, Sedighi T, Shohaimi S, et al. Using machine learning algorithms to develop a clinical decision-making tool for COVID-19 inpatients. Int J Environ Res Public Health. 2021;18(12):6228. doi: 10.3390/ijerph18126228.
- Sakr S, Elshawi R, Ahmed A, Qureshi WT, Brawner C, Keteyian S, et al. Using machine learning on cardiorespiratory fitness data for predicting hypertension: the Henry Ford ExercIse Testing (FIT) Project. PLoS One. 2018;13(4):e0195344. doi: 10.1371/journal.pone.0195344.
- Levin AT, Hanage WP, Owusu-Boaitey N, Cochran KB, Walsh SP, Meyerowitz-Katz G. Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications. Eur J Epidemiol. 2020;35(12):1123-38. doi: 10.1007/s10654-020-00698-1.
- Ho FK, Petermann-Rocha F, Gray SR, Jani BD, Katikireddi SV, Niedzwiedz CL, et al. Is older age associated with COVID-19 mortality in the absence of other risk factors? General population cohort study of 470,034 participants. PLoS One. 2020;15(11):e0241824. doi: 10.1371/journal.pone.0241824.
- Dessie ZG, Zewotir T. Mortality-related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423,117 patients. BMC Infect Dis. 2021;21(1):855. doi: 10.1186/s12879-021-06536-3.
- Hesni E, Sayad B, Khosravi Shadmani F, Najafi F, Khodarahmi R, Rahimi Z, et al. Demographics, clinical characteristics, and outcomes of 27,256 hospitalized COVID-19 patients in Kermanshah province, Iran: a retrospective one-year cohort study. BMC Infect Dis. 2022;22(1):319. doi: 10.1186/s12879- 022-07312-7.
- Albitar O, Ballouze R, Ooi JP, Sheikh Ghadzi SM. Risk factors for mortality among COVID-19 patients. Diabetes Res Clin Pract. 2020;166:108293. doi: 10.1016/j. diabres.2020.108293.
- Peckham H, de Gruijter NM, Raine C, Radziszewska A, Ciurtin C, Wedderburn LR, et al. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nat Commun. 2020;11(1):6317. doi: 10.1038/ s41467-020-19741-6.
- Trouillet-Assant S, Viel S, Ouziel A, Boisselier L, Rebaud P, Basmaci R, et al. Type I interferon in children with viral or bacterial infections. Clin Chem. 2020;66(6):802-8. doi: 10.1093/clinchem/hvaa089.
- Sohrabi MR, Amin R, Maher A, Bahadorimonfared A, Janbazi S, Hannani K, et al. Sociodemographic determinants and clinical risk factors associated with COVID-19 severity: a cross-sectional analysis of over 200,000 patients in Tehran, Iran. BMC Infect Dis. 2021;21(1):474. doi: 10.1186/s12879- 021-06179-4.
- Bashirian S, Mohammadi-Khoshnoud M, Khazaei S, Talebighane E, Keramat F, Bahreini F, et al. Identification of risk factors for COVID-19-related death using machine learning methods. Tanaffos. 2022;21(1):54-62.
- Hernández-Cárdenas CM, Choreño-Parra JA, Torruco-Sotelo C, Jurado F, Serna-Secundino H, Aguilar C, et al. Clinical risk factors for mortality among critically ill Mexican patients with COVID-19. Front Med (Lausanne). 2021;8:699607. doi: 10.3389/fmed.2021.699607.
- Sharifi F, Mehrolhassani MH, Ahmadi Gohari M, Karamoozian A, Jahani Y. Clinical risk factors of need for intensive care unit admission of COVID-19 patients; a cross-sectional study. Arch Acad Emerg Med. 2023;11(1):e15. doi: 10.22037/aaem. v11i1.
- Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43. doi: 10.1001/jamainternmed.2020.0994.
- Shi L, Wang Y, Wang Y, Duan G, Yang H. Dyspnea rather than fever is a risk factor for predicting mortality in patients with COVID-19. J Infect. 2020;81(4):647-79. doi: 10.1016/j. jinf.2020.05.013.
- Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis. J Infect. 2020;81(2):e16-25. doi: 10.1016/j.jinf.2020.04.021.
- Trigo J, García-Azorín D, Planchuelo-Gómez Á, Martínez- Pías E, Talavera B, Hernández-Pérez I, et al. Factors associated with the presence of headache in hospitalized COVID-19 patients and impact on prognosis: a retrospective cohort study. J Headache Pain. 2020;21(1):94. doi: 10.1186/ s10194-020-01165-8.
- Gonzalez-Martinez A, Fanjul V, Ramos C, Serrano Ballesteros J, Bustamante M, Villa Martí A, et al. Headache during SARS-CoV-2 infection as an early symptom associated with a more benign course of disease: a case-control study. Eur J Neurol. 2021;28(10):3426-36. doi: 10.1111/ene.14718.
- Rees EM, Nightingale ES, Jafari Y, Waterlow NR, Clifford S, Pearson CA, et al. COVID-19 length of hospital stay: a systematic review and data synthesis. BMC Med. 2020;18(1):270. doi: 10.1186/s12916-020-01726-3.
- Adham D, Habibzadeh S, Ghobadi H, Asghari Jajin S, Abbasi-Ghahramanloo A, Moradi-Asl E. Epidemiological characteristics and mortality risk factors among COVID-19 patients in Ardabil, northwest of Iran. BMC Emerg Med. 2021;21(1):67. doi: 10.1186/s12873-021-00463-x .
- Nikpouraghdam M, Jalali Farahani A, Alishiri G, Heydari S, Ebrahimnia M, Samadinia H, et al. Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: a single center study. J Clin Virol. 2020;127:104378. doi: 10.1016/j.jcv.2020.104378.
- Noor FM, Islam MM. Prevalence and associated risk factors of mortality among COVID-19 patients: a meta-analysis. J Community Health. 2020;45(6):1270-82. doi: 10.1007/ s10900-020-00920-x.
- Jafari H, Ranjbari M. Alkaloids derived from marine algae and their therapeutic properties–mini-review. J Mar Med. 2019;1(1):3-10. [Persian].