Klein Ana, Bastard Mathieu, Hemat Hamayoun, Singh Saschveen, Muniz Bruno, Manangama Guyguy, Alayyan Amber, Tamanna Abdul Hakim, Barakzaie Bashir, Popal Nargis, Kakar Mohammad Azeem Zmarial, Poulet Elisabeth, Finger Flavio
Epicentre, Paris, France.
Médecins sans Frontières, Kabul, Afghanistan.
PLOS Glob Public Health. 2023 Aug 24;3(8):e0001687. doi: 10.1371/journal.pgph.0001687. eCollection 2023.
Though many studies on COVID have been published to date, data on COVID-19 epidemiology, symptoms, risk factors and severity in low- and middle-income countries (LMICS), such as Afghanistan are sparse. To describe clinical characteristics, severity, and outcomes of patients hospitalized in the MSF COVID-19 treatment center (CTC) in Herat, Afghanistan and to assess risk factors associated with severe outcomes. 1113 patients were included in this observational study between June 2020 and April 2022. Descriptive analysis was performed on clinical characteristics, complications, and outcomes of patients. Univariate description by Cox regression to identify risk factors for an adverse outcome was performed. Adverse outcome was defined as death or transfer to a level 3 intensive care located at another health facility. Finally, factors identified were included in a multivariate Cox survival analysis. A total of 165 patients (14.8%) suffered from a severe disease course, with a median time of 6 days (interquartile range: 2-11 days) from admission to adverse outcome. In our multivariate model, we identified male gender, age over 50, high O2 flow administered during admission, lymphopenia, anemia and O2 saturation < = 93% during the first three days of admission as predictors for a severe disease course (p<0.05). Our analysis concluded in a relatively low rate of adverse outcomes of 14.8%. This is possibly related to the fact that the resources at an MSF-led facility are higher, in terms of human resources as well as supply of drugs and biomedical equipment, including oxygen therapy devices, compared to local hospitals. Predictors for severe disease outcomes were found to be comparable to other settings.
尽管迄今为止已经发表了许多关于新冠病毒的研究，但在阿富汗等低收入和中等收入国家（LMICs），关于新冠疫情的流行病学、症状、风险因素和严重程度的数据却很稀少。为了描述在阿富汗赫拉特的无国界医生组织新冠治疗中心（CTC）住院患者的临床特征、严重程度和结局，并评估与严重结局相关的风险因素。在2020年6月至2022年4月期间，1113名患者被纳入这项观察性研究。对患者的临床特征、并发症和结局进行了描述性分析。通过Cox回归进行单变量描述以确定不良结局的风险因素。不良结局定义为死亡或转至位于另一家医疗机构的三级重症监护病房。最后，将确定的因素纳入多变量Cox生存分析。共有165名患者（14.8%）经历了严重病程，从入院到出现不良结局的中位时间为6天（四分位间距：2-11天）。在我们的多变量模型中，我们确定男性、年龄超过50岁、入院期间给予的高氧流量、淋巴细胞减少、贫血以及入院前三天的氧饱和度<=93%是严重病程的预测因素（p<0.05）。我们的分析得出不良结局发生率相对较低，为14.8%。这可能与以下事实有关：与当地医院相比，无国界医生组织主导的机构在人力资源以及药品和生物医学设备供应（包括氧疗设备）方面资源更充足。发现严重疾病结局的预测因素与其他情况相当。
