Clinical Characteristics and Outcomes of Patients Hospitalized for COVID-19 in Africa: Early Insights from the Democratic Republic of the Congo

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract.

Little is known about the clinical features and outcomes of SARS-CoV-2 infection in Africa. We conducted a retrospective cohort study of patients hospitalized for COVID-19 between March 10, 2020 and July 31, 2020 at seven hospitals in Kinshasa, Democratic Republic of the Congo (DRC). Outcomes included clinical improvement within 30 days (primary) and in-hospital mortality (secondary). Of 766 confirmed COVID-19 cases, 500 (65.6%) were male, with a median (interquartile range [IQR]) age of 46 (34–58) years. One hundred ninety-one (25%) patients had severe/critical disease requiring admission in the intensive care unit (ICU). Six hundred twenty patients (80.9%) improved and were discharged within 30 days of admission. Overall in-hospital mortality was 13.2% (95% CI: 10.9–15.8), and almost 50% among those in the ICU. Independent risk factors for death were age < 20 years (adjusted hazard ratio [aHR] = 6.62, 95% CI: 1.85–23.64), 40–59 years (aHR = 4.45, 95% CI: 1.83–10.79), and ≥ 60 years (aHR = 13.63, 95% CI: 5.70–32.60) compared with those aged 20–39 years, with obesity (aHR = 2.30, 95% CI: 1.24–4.27), and with chronic kidney disease (aHR = 5.33, 95% CI: 1.85–15.35). In marginal structural model analysis, there was no statistically significant difference in odds of clinical improvement (adjusted odds ratio [aOR] = 1.53, 95% CI: 0.88–2.67, P = 0.132) nor risk of death (aOR = 0.65, 95% CI: 0.35–1.20) when comparing the use of chloroquine/azithromycin versus other treatments. In this DRC study, the high mortality among patients aged < 20 years and with severe/critical disease is of great concern, and requires further research for confirmation and targeted interventions.

Related collections

Most cited references 51

Record: found
Abstract: found
Article: not found

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

0 comments Cited 21818 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

0 comments Cited 13560 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou, Ting Yu, Ronghui Du … (2020)

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

0 comments Cited 13451 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Am J Trop Med Hyg

Journal ID (iso-abbrev): Am J Trop Med Hyg

Journal ID (publisher-id): tpmd

Journal ID (hwp): tropmed

Title: The American Journal of Tropical Medicine and Hygiene

Publisher: The American Society of Tropical Medicine and Hygiene

ISSN (Print): 0002-9637

ISSN (Electronic): 1476-1645

Publication date (Print): December 2020

Publication date (Electronic): 02 October 2020

Publication date PMC-release: 02 October 2020

Volume: 103

Issue: 6

Pages: 2419-2428

Affiliations

[1 ]Department of Medicine, Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa;

[2 ]Department of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

[3 ]Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania;

[4 ]Community Health Department, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo;

[5 ]Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo;

[6 ]Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium;

[7 ]African Center of Biostatistics Excellence (ACBE), Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa;

[8 ]Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland;

[9 ]International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria;

[10 ]Department of Paediatrics, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana;

[11 ]Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo;

[12 ]Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of the Congo;

[13 ]Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research (INRB), Kinshasa, Democratic Republic of the Congo;

[14 ]Direction Surveillance Épidémiologique (DSE), Direction Générale de Lutte contre la Maladie (DGLM), Ministère de la Santé Publique et Riposte COVID-19, Kinshasa, Democratic Republic of the Congo;

[15 ]Faculty of Medicine, University of Mbuji-Mayi, Mbuji-Mayi, Democratic Republic of the Congo;

[16 ]Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia;

[17 ]Department of Real World & Advanced Analytics, Cytel, Vancouver, Canada;

[18 ]Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada;

[19 ]Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania;

[20 ]Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, United Kingdom;

[21 ]National Institute for Health Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom;

[22 ]Department of Internal Medicine, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo

Author notes

[* ]Address correspondence to Jean B. Nachega, Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh Graduate School of Public Health, 130 DeSoto St., Crabtree Hall A531, Pittsburgh, PA 15261. E-mail: jbn16@ 123456pitt.edu

Financial support: J. B. N. is an infectious diseases internist and epidemiologist supported by the U.S. NIH/National Institutes of Allergy and Infectious Diseases grant number 5U01AI069521 (Stellenbosch University Clinical Trial Unit of the AIDS Clinical Trial Group) as well as NIH/Fogarty International Center grant numbers 1R25TW011217-01 (African Association for Health Professions Education and Research) and 1D43TW010937-01A1 (University of Pittsburgh HIV Comorbidities Research Training Program in South Africa) and is coprincipal investigator of TOGETHER, an adaptive randomized clinical trial of novel agents for treatment of high-risk outpatient COVID-19 patients in South Africa supported by the Bill & Melinda Gates Foundation. DKI, CB-PN, PM-K, ENK, GMM, JMS, MTP, SA-M, J-JMT, DJML, and J-MK are members of the DRC Ministry of Health′s COVID-19 Multi-Sectoral Response Committee. A. Z. is a coprincipal investigator of the Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET; https://www.pandora-id.net/) funded by the EU Horizon 2020 Framework Program for Research and Innovation and is in receipt of an U.K. NIH Research Senior Investigator award. N. A. S. A. is a clinician-scientist with pediatric infectious disease expertise and is funded by the NIH/National Institute of Child Health and Human Development grant R01HD089866, and by an NIH/Fogarty International Center award under the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA), for the Central and West Africa Implementation Science Alliance (CAWISA).

Authors’ addresses: Jean B. Nachega, Department of Medicine, Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Department of Epidemiology, Infectious Diseases and Microbiology, and Center for Global Health, University of Pittsburgh, Pittsburgh, PA, E-mail: jbn16@ 123456pitt.edu . Daniel Katuashi Ishoso, Community Health Department, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, E-mail: dishosok@ 123456gmail.com . John Otshudiema Otokoye, Joule Ntwan Madinga, and Marie Claire Kolié, Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo, E-mails: johnotokoye@ 123456gmail.com , jmadinga@ 123456yahoo.fr , and marieclairekolie@ 123456gmail.com . Michel P. Hermans, Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium, E-mail: michel.hermans@ 123456uclouvain.be . Rhoderick Neri Machekano, African Center of Biostatistics Excellence (ACBE), Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, E-mail: rhoderick@ 123456sun.ac.za . Nadia A. Sam-Agudu, Institute of Human Virology Nigeria, International Research Center of Excellence, Abuja, Nigeria, and Division of Epidemiology and Prevention, Institute of Human Virology, Baltimore, MD, E-mail: nsamagudu@ 123456ihvnigeria.org . Christian Bongo-Pasi Nswe and Don Jethro Mavungu Landu, Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo, and Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of the Congo, E-mails: bongopanoudji@ 123456gmail.com and jethromavungu@ 123456gmail.com . Placide Mbala-Kingebeni, Department of Microbiology, Institut National de Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo, E-mail: mbalaplacide@ 123456gmail.com . Stéphane Mukendi, Edith N. Nkwembe, and Jean-Jacques Muyembe-Tamfum, Department of Virology, Faculty of Medicine, National Institute of Biomedical Research (INRB), University of Kinshasa, Kinshasa, Democratic Republic of the Congo, E-mails: mukendisteph1@ 123456gmail.com , edithnkwembe1@ 123456gmail.com , and jjmuyembet@ 123456gmail.com . Steve Ahuka-Mundeke, Technical Secretariat, Ebola Response, Goma, Democratic Republic of the Congo, E-mail: amstev04@ 123456yahoo.fr . Gisele M. Mbuyi and Justus M. Nsio, Direction Surveillance Épidémiologique (DSE), Direction Générale de Lutte contre la Maladie (DGLM), Ministère de la Santé Publique et Riposte COVID-19, Kinshasa, Democratic Republic of the Congo, E-mails: drgmbuyi@ 123456gmail.com and justsusnsio@ 123456gmail.com . Didier Mukeba Tshialala, Department of Medicine, Faculty of Medicine, University of Mbuji-Mayi, Mbuji-Mayi, Democratic Republic of the Congo, E-mail: dimutshia@ 123456yahoo.fr . Michel Tshiasuma Pipo, Department of Public Health, Faculty of Medicine, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo, E-mail: mycky1974@ 123456gmail.com . Lynne Mofenson, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, E-mail: mofensol@ 123456gmail.com . Gerald Smith, Department of Real World & Advanced Analytics, Cytel, Vancouver, Canada, E-mail: gerald.smith@ 123456cytel.com . Edward J. Mills, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada, E-mail: emills@ 123456mteksciences.com . John W. Mellors, Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, E-mail: jwm1@ 123456pitt.edu . Alimuddin Zumla, Division of Infection and Immunity, Department of Infection, University College London, London, United Kingdom, E-mail: a.zumla@ 123456ucl.ac.uk . Jean-Marie Kayembe, Department of Medical Microbiology and Virology, Faculty of Medicine, National Institute of Biomedical Research (INRB), University of Kinshasa, Kinshasa, Democratic Republic of the Congo, E-mail: jm.kayembe@ 123456unikin.ac.cd .

[†]

These authors contributed equally to this work.

[‡]

These authors contributed equally to this work.

Article

Publisher ID: tpmd201240

DOI: 10.4269/ajtmh.20-1240

PMC ID: 7695108

PubMed ID: 33009770

SO-VID: 2e96e27b-0fbb-47df-b88f-6ffd0b03db83

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 21 September 2020

Date accepted : 27 September 2020

Page count

Pages: 10

Comments

Comment on this article

scite_

Cited by 52

See all cited by

Most referenced authors 3,094

See all reference authors

- Version 1
- Version 1

Clinical Characteristics and Outcomes of Patients Hospitalized for COVID-19 in Africa: Early Insights from the Democratic Republic of the Congo

Read this article at

Abstract.

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 51

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Clinical Characteristics of Coronavirus Disease 2019 in China

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Author and article information

Journal

Affiliations

Author notes

Article

History

Page count

Categories

Comments

Comment on this article

Similar content 234

Cited by 52

Most referenced authors 3,094