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

Abstract Objectives: To analyze the clinical and biological characteristics and to evaluate the risk factors associated to the mortality of patients with COVID-19 in Commune 4 of the District of Bamako. Methods: The cohort consisted of COVID-19 patients treated from March 2020 to June 2022 at the Bamako Dermatology Hospital and the Pasteur private Polyclinic in Commune 4 in Bamako. The variables studied 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 test the risk factors for mortality. Results: Among the 1319 patients included, 38.4% were asymptomatic, 46% and 15.5% developed moderate and severe forms respectively. The predominant signs were cough (48.5%), respiratory difficulty (24.6%) and headache (19.7%). There was a male predominance of 58.2%. High blood pressure (19.9%) and diabetes (10%) are the main comorbidities. Men were in the majority (58.2%). High blood pressure (19.9%) and diabetes (10%) are the main comorbidities. D-dimer<500µg/l was found in 53.3% of cases and the mean hemoglobin level was 12.9±1.7g/l. The case fatality rate was 3.71% in our series. In bivariate analysis, age>60 years, High blood pressure, diabetes, clinical severity, D-dimer <500 µg/l were associated with death. By the logistic regression method, age >60 years, increased heart rate, the severity of disease and mainly acute respiratory distress syndrome (polypnea, respiratory difficulty) were the factors associated with death. Conclusion: These main findings elucidate the factors associated with severity and lethality outside of health care system constraints. Old age, heart rate and the development of respiratory distress were the factors associated with increased fatalities.