Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia

doi:10.3390/healthcare9121608

. 2021 Nov 23;9(12):1608.

doi: 10.3390/healthcare9121608.

Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia

Khalid A Alhasan¹, Mohamed A Shalaby^{2

3}, Mohamad-Hani Temsah¹, Fadi Aljamaan⁴, Reem Shagal¹, Talal AlFaadhel⁵, Mohammed Alomi⁶, Khalid AlMatham⁷, Adi J AlHerbish¹, Rupesh Raina^{8

9}, Sidharth K Sethi¹⁰, Sarah Alsubaie¹, Marwah H Hakami¹¹, Najla M Alharbi¹¹, Razan A Shebeli¹¹, Hanan Mohamed Nur¹¹, Ohoud F Kashari¹¹, Faiza A Qari¹², Amr S Albanna¹³, Jameela A Kari^{2

3}

Affiliations

¹ Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia.
² Pediatric Nephrology Center of Excellence, Department of Pediatrics, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
³ Department of Pediatrics, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia.
⁴ Critical Care Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia.
⁵ Department of Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia.
⁶ Prince Mohammed bin Abdulaziz Hospital, King Salman Center for Kidney Diseases, Ministry of Health, Riyadh 14214, Saudi Arabia.
⁷ King Fahad Medical City, Ministry of Health, Riyadh 11525, Saudi Arabia.
⁸ Pediatrics Nephrology, Akron Children's Hospital, Akron, OH 44241, USA.
⁹ Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, OH 44241, USA.
¹⁰ Pediatric Nephrology, Medanta, The Medicity, Gurgaon 122001, India.
¹¹ Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia.
¹² Department of Medicine, College of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
¹³ King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 11481, Saudi Arabia.

PMID: 34946347
PMCID: PMC8701249
DOI: 10.3390/healthcare9121608

Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia

Khalid A Alhasan et al. Healthcare (Basel). 2021.

. 2021 Nov 23;9(12):1608.

doi: 10.3390/healthcare9121608.

Authors

Affiliations

¹ Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia.
² Pediatric Nephrology Center of Excellence, Department of Pediatrics, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
³ Department of Pediatrics, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia.
⁴ Critical Care Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia.
⁵ Department of Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia.
⁶ Prince Mohammed bin Abdulaziz Hospital, King Salman Center for Kidney Diseases, Ministry of Health, Riyadh 14214, Saudi Arabia.
⁷ King Fahad Medical City, Ministry of Health, Riyadh 11525, Saudi Arabia.
⁸ Pediatrics Nephrology, Akron Children's Hospital, Akron, OH 44241, USA.
⁹ Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, OH 44241, USA.
¹⁰ Pediatric Nephrology, Medanta, The Medicity, Gurgaon 122001, India.
¹¹ Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia.
¹² Department of Medicine, College of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
¹³ King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 11481, Saudi Arabia.

PMID: 34946347
PMCID: PMC8701249
DOI: 10.3390/healthcare9121608

Abstract

Background: SARS-CoV-2 infection has a high mortality rate and continues to be a global threat, which warrants the identification of all mortality risk factors in critically ill patients.

Methods: This is a retrospective multicenter cohort study conducted in five hospitals in the Kingdom of Saudi Arabia (KSA). We enrolled patients with confirmed SARS-COV-2 infection admitted to any of the intensive care units from the five hospitals between March 2020 and July 2020, corresponding to the peak of recorded COVID-19 cases in the KSA.

Results: In total, 229 critically ill patients with confirmed SARS-CoV-2 infection were included in the study. The presenting symptoms and signs of patients who died during hospitalization were not significantly different from those observed among patients who survived. The baseline comorbidities that were significantly associated with in-hospital mortality were diabetes (62% vs. 48% among patients who died and survived (p = 0.046)), underlying cardiac disease (38% vs. 19% (p = 0.001)), and underlying kidney disease (32% vs. 12% (p < 0.001)).

Conclusion: In our cohort, the baseline comorbidities that were significantly associated with in-hospital mortality were diabetes, underlying cardiac disease, and underlying kidney disease. Additionally, the factors that independently influenced mortality among critically ill COVID-19 patients were high Activated Partial Thromboplastin Time (aPTT )and international normalization ratio (INR), acidosis, and high ferritin.

Keywords: COVID-19 disease; SARS-CoV-2 infection; Saudi Arabia; outcomes; risk of mortality.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Baseline comorbidities in critically ill patients with COVID-19 stratified by survival outcome. Abbreviations: CNS, central nervous system; Dis., disease; HIV, human immunodeficiency virus.

**Figure 2**
Presenting symptoms (A) and signs (B) in critically ill patients with COVID-19 stratified by survival outcome. Abbreviations: URTI, upper respiratory tract infection.

See this image and copyright information in PMC

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[1] Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y., Zhang L., Fan G., Xu J., Gu X., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed

[2] Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y., Zhang L., Fan G., Xu J., Gu X., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed

[3] Salata C., Calistri A., Parolin C., Palù G. Coronaviruses: A paradigm of new emerging zoonotic diseases. Pathog. Dis. 2019;77:ftaa006. doi: 10.1093/femspd/ftaa006. - DOI - PMC - PubMed

[4] Salata C., Calistri A., Parolin C., Palù G. Coronaviruses: A paradigm of new emerging zoonotic diseases. Pathog. Dis. 2019;77:ftaa006. doi: 10.1093/femspd/ftaa006. - DOI - PMC - PubMed

[5] Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) 2020. [(accessed on 4 August 2021)]. Available online: https://coronavirus.jhu.edu/map-faq.

[6] Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) 2020. [(accessed on 4 August 2021)]. Available online: https://coronavirus.jhu.edu/map-faq.

[7] Yezli S., Khan A. COVID-19 social distancing in the Kingdom of Saudi Arabia: Bold measures in the face of political, economic, social and religious challenges. Travel Med. Infect. Dis. 2020;37:101692. doi: 10.1016/j.tmaid.2020.101692. - DOI - PMC - PubMed

[8] Yezli S., Khan A. COVID-19 social distancing in the Kingdom of Saudi Arabia: Bold measures in the face of political, economic, social and religious challenges. Travel Med. Infect. Dis. 2020;37:101692. doi: 10.1016/j.tmaid.2020.101692. - DOI - PMC - PubMed

[9] Al-Tawfiq J.A., Memish Z.A. COVID-19 in the Eastern Mediterranean region and Saudi Arabia: Prevention and therapeutic strategies. Int. J. Antimicrob. Agents. 2020;55:105968. doi: 10.1016/j.ijantimicag.2020.105968. - DOI - PMC - PubMed

[10] Al-Tawfiq J.A., Memish Z.A. COVID-19 in the Eastern Mediterranean region and Saudi Arabia: Prevention and therapeutic strategies. Int. J. Antimicrob. Agents. 2020;55:105968. doi: 10.1016/j.ijantimicag.2020.105968. - DOI - PMC - PubMed

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Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia

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Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia

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