Risk Factors for Severe and Critical COVID-19 in a Cohort of Syrians: A Retrospective Cross-Sectional Study

Abstract

Abstract:

Background and Aim: Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented morbidity and mortality worldwide. The clinical course of the disease and the spectrum of its outcomes have been characterized by inter-individual, inter-racial and inter-ethnic variations in severity, ranging from asymptomatic and mild infection to severe and critical illness and even death. Our study aimed to identify host-specific risk factors associated with the severity of COVID-19 infection in a cohort of Syrian adults of both sexes and different age groups.

Methods and study subjects: This study was designed as a retrospective survey-based published between July and September of 2021. Individuals who filled the electronic questionnaire were interviewed to verify demographic data, severity of symptoms of COVID-19 infection, comorbidities, and the results of tests and laboratory assays approved for diagnosis. Patients were classified according severity of COVID-19 into four categories based on the COVID-19 Treatment Guidelines issued by the National Institutes of Health (NIH). Microsoft Excel 2016 and GraphPad Prism (version 6.01) software were used to conduct statistical analyses and graphic representation, and the level of statistical significance was set at p=0.05.Results: The number of participants with confirmed diagnosis was 170 individuals, with (54.71%) being females. Thirty-Seven patients (21.76%) were classified in the “severe infection” category and 16 patients (9.41%) met the “critical disease” criteria. The hospitalization rate was 34%, distributed between 21/38 (55.21%) severe infection cases and all 16/16 critical cases (100%). Young participants (<50 years old) constituted the dominant age group (71.18%), whereas the percentage of elderly (≤65 years) did not exceed 12.94%, and smokers 37.64%. General fatigue/weakness (75%), followed by loss of sense of smell and/or taste (51.19%) topped the spectrum of symptoms and complaints. The majority of critical cases were overweight (BMI ≥25 kg/m²) (81.25%), diagnosed with hypertension (75%) and/or diabetes (37.5%), and elderly (≤65 years) (68.75%), compared with lower percentages in severe, moderate, and mild infections, with statistically significant differences (p<<0.05 for all comparisons). Severe and critical infections were associated with older age (50≤ years old) (Odds Ratio [OR]= 6.597, 95% CI 3.160-13.775, p= <0.0001), (65≤ years old ) (OR= 21.748, 96% CI 6.049-78.188, p <0.0001), overweight (BMI ≥25 kg/m²) (OR= 2.256, 95% CI 1.139-4.467, p= 0.0197), or obesity (BMI ≥30 kg/m²) (OR= 2.256, 95% CI 1.1.139 -4.467, p= 0.0019), and concomitant chronic medications ( high blood pressure (OR= 5.805, 95% CI 2.710-12.434, p= 0.0001) and diabetes (OR= 13.500, 95% CI 4.052-44.975, p <0.0001).Conclusions: The likelihood of severe and critical COVID-19 disease increases with age, overweight or obesity, and the presence of chronic comorbidities (prominently hypertension, diabetes mellitus and cardiovascular disease). This study contributes to identifying predictors of COVID-19 severity and classifying Syrian patients based on the predicted degree of risk, which would feed into the treatment decision-making process by health care providers.Key Words: COVID-19, Risk Factors, Severity, Obesity, Age, Comorbidity, Hypertension, Diabetes.