Factors of progression to severity and death in COVID-19 patients at two health care sites in Bamako, Mali.

Objectives: To analyze the clinical and biological characteristics and to evaluate the risk factors associated with the mortality of patients with COVID-19 in Commune IV of the District of Bamako.

Methods: The cohort consisted of COVID-19 patients managed from March 2020 to June 2022 at the Bamako Dermatology Hospital and the Pasteur Polyclinic in Commune IV in Bamako. The studied variables were sociodemographic, clinical, and biological. For the analysis of deaths, explanatory variables were grouped into sociodemographic factors, comorbidities and symptoms. Binomial logistic regression models were used to identify mortality associated risk factors.

Results: Among the 1319 included patients, 38.4% were asymptomatic, 46% and 15.5% developed moderate or severe COVID-19 respectively. The predominant signs were cough (48.5%), respiratory difficulty (24.6%) and headache (19.7%). Male were more common (58.2%). High blood pressure (19.9%) and diabetes (10%) were the main comorbidities. D-dimers < 0.5 μg/l was found in 53.3% of cases and the mean hemoglobin level was 12.9 ± 1.7 g/l. The case fatality rate was 3.71% in our series. In bivariate analysis, age > 60 years, high blood pressure, diabetes, clinical severity, D-dimers < 0.5 μg/l were associated with death. Using binomial logistic regression method, age > 60 years, increased heart rate, disease severity level and mainly acute respiratory distress syndrome (polypnea, difficulty breathing) were the factors found associated with death. After adjusting for all the assessed factors, age < 60 years [aHR = 0.15 (0.06-0.35)] and administration of azithromycin [aHR = 0.31 (0.1-0.97)] were protective factors while higher respiratory rate [aHR = 1.14 (1.07-1.22)] and difficulty breathing [aHR = 3.06 (1.03-9.13)] were risk factors associated with death.

Conclusion: These main findings elucidate the factors associated with severity and lethality external of health care system constraints. Advanced age, higher heart rate and the development of respiratory distress were the factors significantly associated with increased fatalities.