Predictors of Mortality among Patients Hospitalized with COVID-19 during the First Wave in India: A Multisite Case-Control Study

Severe acute respiratory syndrome coronavirus 2 disease (COVID-19) has caused more than 6 million deaths globally. Understanding predictors of mortality will help in prioritizing patient care and preventive approaches. This was a multicentric, unmatched, hospital-based case-control study conducted in nine teaching hospitals in India. Cases were microbiologically confirmed COVID-19 patients who died in the hospital during the period of study and controls were microbiologically confirmed COVID-19 patients who were discharged from the same hospital after recovery. Cases were recruited sequentially from March 2020 until December–March 2021. All information regarding cases and controls was extracted retrospectively from the medical records of patients by trained physicians. Univariable and multivariable logistic regression was done to assess the association between various predictor variables and deaths due to COVID-19. A total of 2,431 patients (1,137 cases and 1,294 controls) were included in the study. The mean age of patients was 52.8 years (SD: 16.5 years), and 32.1% were females. Breathlessness was the most common symptom at the time of admission (53.2%). Increasing age (adjusted odds ratio [aOR]: 46–59 years, 3.4 [95% CI: 1.5–7.7]; 60–74 years, 4.1 [95% CI: 1.7–9.5]; and ≥ 75 years, 11.0 [95% CI: 4.0–30.6]); preexisting diabetes mellitus (aOR: 1.9 [95% CI: 1.2–2.9]); malignancy (aOR: 3.1 [95% CI: 1.3–7.8]); pulmonary tuberculosis (aOR: 3.3 [95% CI: 1.2–8.8]); breathlessness at the time of admission (aOR: 2.2 [95% CI: 1.4–3.5]); high quick Sequential Organ Failure Assessment score at the time of admission (aOR: 5.6 [95% CI: 2.7–11.4]); and oxygen saturation < 94% at the time of admission (aOR: 2.5 [95% CI: 1.6–3.9]) were associated with mortality due to COVID-19. These results can be used to prioritize patients who are at increased risk of death and to rationalize therapy to reduce mortality due to COVID-19.