Predictors of poor clinical outcome in COVID-19 patients: a finding from the tropics.
Authors: Kebede Yabets Tesfaye , Hassen Hanna Defar , Menebo Mesay Moges 
Published: August 2022

Background
In the wake of a new COVID-19 wave, and on the verge of a new pandemic -monkeypox, what is key to patient care is how well we comprehended how previous waves unfolded. Because by understanding the past, we can better intervene on what is to come. Given patient symptom profile of a COVID-19 diagnosed patient is very indicative or predictive of the illness outcome, adequate information of such relationships have utmost clinical importance: that is an illness can be better treated, and patient care can be better prioritized based on urgency. Despite the literature is rich in reporting such relationships, it has still limitations. First and foremost, the findings come from across different but localized regions of the world and these regions are mainly non-tropical and extrapolating these findings to health decisions in tropical regions might be ill based. Second, limited amount of prediction tools has been prospectively evaluated or validated for clinical management.
Objectives
The study assesses presentation symptom profile, lab-findings, socio-demographic data of COVID-19 patients hospitalized in a tropic country and determines factors associated with poor outcome.
Methods
A cross-sectional study design using retrospective review of medical records was used on patients diagnosed with COVID-19 and admitted to a COVID treatment center in Ethiopia. We tested the direct effect of the identified independent variables on disease severity (measured on a five items scale ; 1 = Asymptomatic, 5 = Critical) and outcome (measured as a dichotomous variable, 1 = survived, 0 = deceased) or a mediation effect on outcome through severity.
Results
Diarrhea, Myalgia, and Loss of taste and smell were reported relatively lesser in this study than it had previously been reported in other studies. The COVID-19 progressed to critical level for patients who had fatigue and shortness of breath. Those with such progression had their survival probability reduced by almost half units. Of the vital sign records, pulse rate and REM score directly predicted outcome, where survival was most probable when having had a lower or medium pulse rate and a lower REM score. Patients who had a higher systolic and a lower mean arterial pressure reading, and those who were reported with a chest finding and a lower oxygen saturation had a higher disease severity progression. Having had comorbidities like hypertension, acute kidney injury and ARDS led to a severe progression of the COVID-19 and eventually predisposed to a lower survival outcome. Superinfection stood out singularly as the strong predictor of death.
Conclusion
The study findings point to the importance of implementing creative means of surveilling COVID-19 variants and a tailored strategy of COVID-19 patient care to the tropics. One possible way of variant monitoring could be to track changes in usual patterns of symptom profiles as a proxy indication of disease mutation and thus possible variant case. With pulse rate, REM, fatigue and shortness of breath strongly predicting COVID-19 outcome, monitoring of these measures as a primary source of disease prognosis can be reliable and be thought of as a successful strategy especially for resource poor countries.