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Study sheds light on Oman’s COVID-19 risk factors

15 Jun 2020

A one-of-its kind study conducted in Oman, shedding light on the risk factors and outcomes of hospitalised COVID-19 patients in Oman, has revealed that the elderly, especially those with diabetes mellitus (DM), high total bilirubin and low corrected calcium were associated with high mortality in hospitalised COVID19 patients.  

The mortality was also associated with 19% of those admitted in the Intensive Care Unit (ICU) and 31% of those put on mechanical ventilation. 

The study, ‘Clinical Characteristics and Outcomes of the first 63 Adult Patients Hospitalised with COVID-19: An experience from Oman’, will soon be published in the Journal of Infection and Public Health.  

“To our knowledge this is the first report describing the clinical characteristics, laboratory parameters and outcomes of COVID-19 infected patients from Oman and the region,” the authors of the research reported in the study.  

“Older age, those with DM, those with high C-reactive protein (CRP) and total bilirubin and those with low calcium on admission were at risk for poor prognosis. Elevated D-dimer, Lactate dehydrogenase (LDH) enzyme, total bilirubin and high partial pressure of carbon dioxide (pCO2) were associated with ICU admission. 

“This manuscript sheds light on the risk factors and outcomes of hospitalised COVID-19 patients in Oman, an information much needed, particularly for policymakers and authorities in the region, besides physicians caring for high risk populations,” the study stated. 

The study was conducted from February 24 to April 24, 2and included patients with laboratory confirmed COVID-19 infection who were admitted to The Royal Hospital and Al Nahdha Hospital. All admitted patients had radiological findings suggestive of pneumonia and/or acute respiratory distress syndrome (ARDS). The study also covered 63 non-pregnant adults above 18 years of age. 

Fifty four per cent (34 patients) and 46% (29 patients) were admitted to Royal and Al Nahdha hospitals, respectively.

The overall mean age of the hospitalised COVID-19 cohort ranged from 22 to 87 years. A total of 87% (or 53) of the patients were males and 46% (29) were Omani citizens. Nearly 78% (49) of the patients were employed.  

Thirteen per cent (8) of the patients had a history of travel to a country with local COVID-19 transmission and 22% (14) had a contact with a known COVID-19 patient, mostly through household contact. The remaining, almost two thirds of the patients had an unknown mode of infection.  

Fifty one per cent (32 patients) had at least one comorbidity, with DM (32%; n = 20) and hypertension (32%; n = 20) as the most common comorbidities followed by chronic heart and renal diseases (6.4%; n = 4). The most prevalent symptoms at onset of illness were fever (84%; n = 53), cough (75%; n = 47) and shortness of breath (59%; n = 37).  

A total of 38% (n = 24) of the hospitalised patients were admitted to ICU. Those admitted to the ICU were more likely to have been employed, had shortness of breath, crepitation’s on chest examination and required oxygen therapy on initial presentation. ICU admission was associated with severe pneumonia, acute respiratory distress syndrome, mechanical ventilation, continuous veno-venous hemodialysis (CVVHD)/ intermittent hemodialysis (ID) and longer hospital stays. 

“Our fatality rate was 8% among admitted patients, which is way lower than reports from elsewhere. This should be interpreted with caution since 24% of our patients were still hospitalised but in a stable condition at the time of writing the manuscript. Our mortality rates were high in patients who were older, diabetic, had high CRP and total bilirubin and in patients with low serum calcium.” 

The study also showed that the percentage of smokers in all groups was very low. “Smoking has been indicated as a risk factor in some reports. However, others reported low percentage of smokers within a group of severe COVID-19 infection. Most of our cohort had no history of cigarette smoking or hookah (shisha) use, as a good number of our cohort were non-nationals, though the possibility exists of other forms of tobacco consumption, such as tobacco chewing, which is a very common habit in certain expatriates more than others.” 

Most of patients admitted with radiological confirmed pneumonia and/or ARDS had fever, cough and shortness of breath. These symptoms have been described as the most common symptoms in COVID-19 patients, indicating a similar host immune response to SARS COV-2.  

The majority of patients were admitted to the ICU because of severe pneumonia and ARDS that required respiratory support and invasive mechanical ventilation in 62% of the patients.  

All hospitalised patients with COVID-19, except one (99%; n = 62) received chloroquine or hydroxychloroquine. Lopinavir/ritonavir combination was also used in 59% of the patients, including all the 24 ICU admitted patients.  
Lopinavir/ritonavir was found to reduce viral loads and improve clinical symptoms during the treatment for coronaviruses, however, it failed to show effectiveness in a recent randomised controlled clinical trial on 199 patients infected with COVID-19.  

The study was contributed by Faryal Khamis, Ibrahim al Zakwani, Hamed al Naamani, Sultan al Lawati, Nenad Pandak, Muna Ba Omar, Maher al Bahrani, Zakaryia al Bulushi, Huda al Khalili, Issa al Salmi, Ruwaida al Salmi and Salah T al Awaidy.

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