Risk factors for COVID-19-related in-hospital mortality in a high HIV and tuberculosis prevalence setting in South Africa: a cohort study.

Autor:	Jassat W; Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa. Electronic address: waasilaj@nicd.ac.za., Cohen C; Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa., Tempia S; Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; MassGenics, Duluth, GA, USA., Masha M; Right to Care, Johannesburg, South Africa., Goldstein S; South Africa Medical Research Council Centre for Health Economics and Decision Science-PRICELESS SA, University of the Witwatersrand, Johannesburg, South Africa., Kufa T; Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa., Murangandi P; Division of Global HIV and TB, Centers for Disease Control and Prevention, Pretoria, South Africa., Savulescu D; Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa., Walaza S; Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa., Bam JL; Western Cape Department of Health, Cape Town, South Africa., Davies MA; Western Cape Department of Health, Cape Town, South Africa., Prozesky HW; Tygerberg Hospital and Division of Infectious Disease, University of Stellenbosch, Cape Town, South Africa., Naude J; Mitchells Plain District Hospital, Cape Town, South Africa., Mnguni AT; Khayelitsha District Hospital, Cape Town, South Africa., Lawrence CA; Western Cape Department of Health, Cape Town, South Africa., Mathema HT; Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa., Zamparini J; Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa., Black J; Livingstone Hospital, Walter Sisulu University, Nelson Mandela Bay, South Africa., Mehta R; Klerksdorp-Tshepong Hospital, University of Witwatersrand, Klerksdorp, South Africa., Parker A; Tygerberg Hospital and Division of Infectious Disease, University of Stellenbosch, Cape Town, South Africa., Chikobvu P; Free State Department of Health, Bloemfontein, South Africa., Dawood H; Grey's Hospital, Pietermaritzburg, South Africa., Muvhango N; Limpopo Department of Health, Polokwane, South Africa., Strydom R; Northern Cape Department of Health, Kimberley, South Africa., Adelekan T; Gauteng Department of Health, Johannesburg, South Africa., Mdlovu B; Mpumalanga Department of Health, Nelspruit, South Africa., Moodley N; KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa., Namavhandu EL; Eastern Cape Department of Health, Bisho, South Africa., Rheeder P; School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa., Venturas J; Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa., Magula N; Department of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa., Blumberg L; Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
Jazyk:	angličtina
Zdroj:	The lancet. HIV [Lancet HIV] 2021 Sep; Vol. 8 (9), pp. e554-e567. Date of Electronic Publication: 2021 Aug 04.
DOI:	10.1016/S2352-3018(21)00151-X
Abstrakt:	Background: The interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis is unclear, particularly in low-income and middle-income countries in Africa. South Africa has a national HIV prevalence of 19% among people aged 15-49 years and a tuberculosis prevalence of 0·7% in people of all ages. Using a nationally representative hospital surveillance system in South Africa, we aimed to investigate the factors associated with in-hospital mortality among patients with COVID-19. Methods: In this cohort study, we used data submitted to DATCOV, a national active hospital surveillance system for COVID-19 hospital admissions, for patients admitted to hospital with laboratory-confirmed SARS-CoV-2 infection between March 5, 2020, and March 27, 2021. Age, sex, race or ethnicity, and comorbidities (hypertension, diabetes, chronic cardiac disease, chronic pulmonary disease and asthma, chronic renal disease, malignancy in the past 5 years, HIV, and past and current tuberculosis) were considered as risk factors for COVID-19-related in-hospital mortality. COVID-19 in-hospital mortality, the main outcome, was defined as a death related to COVID-19 that occurred during the hospital stay and excluded deaths that occurred because of other causes or after discharge from hospital; therefore, only patients with a known in-hospital outcome (died or discharged alive) were included. Chained equation multiple imputation was used to account for missing data and random-effects multivariable logistic regression models were used to assess the role of HIV status and underlying comorbidities on COVID-19 in-hospital mortality. Findings: Among the 219 265 individuals admitted to hospital with laboratory-confirmed SARS-CoV-2 infection and known in-hospital outcome data, 51 037 (23·3%) died. Most commonly observed comorbidities among individuals with available data were hypertension in 61 098 (37·4%) of 163 350, diabetes in 43 885 (27·4%) of 159 932, and HIV in 13 793 (9·1%) of 151 779. Tuberculosis was reported in 5282 (3·6%) of 146 381 individuals. Increasing age was the strongest predictor of COVID-19 in-hospital mortality. Other factors associated were HIV infection (adjusted odds ratio 1·34, 95% CI 1·27-1·43), past tuberculosis (1·26, 1·15-1·38), current tuberculosis (1·42, 1·22-1·64), and both past and current tuberculosis (1·48, 1·32-1·67) compared with never tuberculosis, as well as other described risk factors for COVID-19, such as male sex; non-White race; underlying hypertension, diabetes, chronic cardiac disease, chronic renal disease, and malignancy in the past 5 years; and treatment in the public health sector. After adjusting for other factors, people with HIV not on antiretroviral therapy (ART; adjusted odds ratio 1·45, 95% CI 1·22-1·72) were more likely to die in hospital than were people with HIV on ART. Among people with HIV, the prevalence of other comorbidities was 29·2% compared with 30·8% among HIV-uninfected individuals. Increasing number of comorbidities was associated with increased COVID-19 in-hospital mortality risk in both people with HIV and HIV-uninfected individuals. Interpretation: Individuals identified as being at high risk of COVID-19 in-hospital mortality (older individuals and those with chronic comorbidities and people with HIV, particularly those not on ART) would benefit from COVID-19 prevention programmes such as vaccine prioritisation as well as early referral and treatment. Funding: South African National Government. Competing Interests: Declaration of interests We declare no competing interests. (Copyright © 2021 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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