Surendra Henry, Elyazar Iqbal Rf, Djaafara Bimandra A, Ekawati Lenny L, Saraswati Kartika, Adrian Verry, Oktavia Dwi, Salama Ngabila, Lina Rosa N, Andrianto Adhi, Lestari Karina D, Burhan Erlina, Shankar Anuraj H, Thwaites Guy, Baird J Kevin, Hamers Raph L
Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.
Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Lancet Reg Health West Pac. 2021 Apr;9:100108. doi: 10.1016/j.lanwpc.2021.100108. Epub 2021 Mar 2.
Data on COVID-19-related mortality and associated factors from low-resource settings are scarce. This study examined clinical characteristics and factors associated with in-hospital mortality of COVID-19 patients in Jakarta, Indonesia, from March 2 to July 31, 2020.
This retrospective cohort included all hospitalised patients with PCR-confirmed COVID-19 in 55 hospitals. We extracted demographic and clinical data, including hospital outcomes (discharge or death). We used logistic regression to examine factors associated with mortality.
Of 4265 patients with a definitive outcome by July 31, 3768 (88%) were discharged and 497 (12%) died. The median age was 46 years (IQR 32-57), 5% were children, and 31% had >1 comorbidity. Age-specific mortalities were 11% (7/61) for <5 years; 4% (1/23) for 5-9; 2% (3/133) for 10-19; 2% (8/638) for 20-29; 3% (26/755) for 30-39; 7% (61/819) for 40-49; 17% (155/941) for 50-59; 22% (132/611) for 60-69; and 34% (96/284) for ≥70. Risk of death was associated with higher age, male sex; pre-existing hypertension, diabetes, or chronic kidney disease; clinical diagnosis of pneumonia; multiple (>3) symptoms; immediate ICU admission, or intubation. Across all ages, risk of death was higher for patients with >1 comorbidity compared to those without; notably the risk was six-fold increased among patients <50 years (adjusted odds ratio 5.87, 95%CI 3.28-10.52; 27% vs 3% mortality).
Overall in-hospital mortality was lower than reported in high-income countries, probably due to younger age distribution and fewer comorbidities. Deaths occurred across all ages, with >10% mortality among children <5 years and adults >50 years.
来自资源匮乏地区的与2019冠状病毒病(COVID-19)相关的死亡率及相关因素的数据稀缺。本研究调查了2020年3月2日至7月31日期间印度尼西亚雅加达COVID-19患者的临床特征及与院内死亡相关的因素。
这项回顾性队列研究纳入了55家医院中所有PCR确诊的COVID-19住院患者。我们提取了人口统计学和临床数据,包括医院结局(出院或死亡)。我们使用逻辑回归分析来研究与死亡率相关的因素。
截至7月31日有明确结局的4265例患者中,3768例(88%)出院,497例(12%)死亡。中位年龄为46岁(四分位间距32 - 57岁),5%为儿童,31%有>1种合并症。各年龄段的死亡率分别为:<5岁为11%(7/61);5 - 9岁为4%(1/23);10 - 19岁为2%(3/133);20 - 29岁为2%(8/638);30 - 39岁为3%(26/755);40 - 49岁为7%(61/819);50 - 59岁为17%(155/941);60 - 69岁为22%(132/611);≥70岁为34%(96/284)。死亡风险与年龄较大、男性、既往有高血压、糖尿病或慢性肾脏病、肺炎的临床诊断、多种(>3种)症状、立即入住重症监护病房或插管有关。在所有年龄段中,有>1种合并症的患者的死亡风险高于无合并症者;值得注意的是,<50岁患者的风险增加了6倍(调整比值比5.87,95%置信区间3.28 - 10.52;死亡率分别为27%和3%)。
总体院内死亡率低于高收入国家报告的水平,可能是由于年龄分布较年轻且合并症较少。各年龄段均有死亡发生,<5岁儿童和>50岁成人的死亡率>10%。