Laboratory biomarkers associated with mortality in COVID-19 patients in Addis Ababa, Ethiopia

Abstract

Background: Laboratory biomarkers are amongst the best imperative predictors of disease outcomes in hospital-admitted COVID-19 patients. Although data is available in this regard at a global level, there is a paucity of information in Ethiopia. Thus, this study aimed to assess the laboratory biomarkers association with death among COVID-19 patients in Ethiopia. Methods: A health facility-based longitudinal study was conducted from 2020 to 2022 among RT-PCR-confirmed COVID-19 patients admitted and on treatment follow-up at COVID-19 treatment hospitals in Addis Ababa. A robust Poisson regression model was fitted to assess the association between demographic, clinical, and laboratory factors and death. Significance was determined at p<0.05, and variables with p < 0.15 in bivariate analyses were included in the final multivariable models. Incidence rate ratio (IRR) with a 95% confidence interval (CI) was used to describe associations. Results: Of the 2357 COVID-19 patients, 248 (10.5%) died. The median age of participants was 59 (IQR= 45- 70) years, and the majority (64.9%) of them were male. Lower median RBC was observed among those who died at 4.58 (4.06-5.07) as compared to those who survived at 4.69 (4.23-5.12) whereas high median (IQR) WBC was a predictor of mortality with 11.2 (7.7-15.9). After adjusting for confounders, death was associated with age >74 years having adjusted incidence rate ratio [aIRR (95%CI): 2.46 (1.40-4.34)], and critical clinical situations [aIRR (95% CI): 4.04 (2.18-7.52)]. Conclusion: Our results demonstrate that abnormal liver function tests, abnormal white blood cells, age of the patients, and clinical status of the patients during admission are associated with unfavorable outcomes of COVID-19. Hence, timely monitoring of these laboratory results at the earliest phase of the disease was highly commendable.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This work was supported and financed by Yekatit 12 Hospital Medical College, with project title, evaluation and determining laboratory profile and biomarkers among COVID-19 patients in Addis Ababa, Ethiopia, Ref # 75/20 and Addis Ababa University through an adaptive problem-solving project, with project title, Evaluation and Validation of the Diagnostic Performance of SARS-CoV-2 Rapid Test for the detection of Novel Corona Virus, Ref #-PR/5.15/590/12/20. No additional external funding was received. The funders are not involved in study design, data collection, and analysis, the decision to publish, or the preparation of the manuscript. The contents are virtuously the responsibility of the authors and do not represent or reflect the funder's view.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The research protocol had been getting approval from different institutional ethics and research committees prior to the analysis. Accordingly it was approved by the IRB of the College of Health Sciences, Addis Ababa University IRB committee (IRB # 029/20/Lab) IRB of the Department of Medical Laboratory Sciences Addis Ababa University (reference #-MLS/174/21) IRB office of Addis Ababa City Administration Health Bureau, AAPHREML (Reference #- AAHB/4039/227) and also by Yekatit 12 Hospital Medical College (IRB protocol # 75/20) and also reviewed and approved by the Ekka Kotebe hospital IRB protocol # Eka-150-5-4). Study participants consented/assented in writing to sample storage and subsequent use of their samples and a waiver of consent was provided by the institutional review board for the use of leftover samples. Moreover this study was conducted per the Helsinki Declarations general guiding principles and regulations.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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Data Availability

All data sets used in this study are included in this manuscript.

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