Risk factors for death in hospitalized COVID-19 patients in Africa: A systematic review and meta-analysis

Abstract

Background: The coronavirus disease 2019 has quickly spread worldwide since it first appeared in Wuhan, China, in late 2019. The most affected country in Africa was South Africa. This study aimed to identify the risk factors for death in hospitalized COVID-19 patients in Africa. Methods: We conducted a systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We searched articles from the following database: PubMed, Embase, Cochrane Library, Medline, and COVID-19 Research Database. We used Google Scholar for gray literature. The language used in this article was English. The last search was conducted on January 15, 2023. Pooled HRs, or ORs, and 95% confidence intervals, were calculated separately to identify the risk factors for death in hospitalized COVID-19 patients. Heterogeneity was assessed by Cochran’s Q statistic and the I 2 test. The Egger test was used to assess publication bias. Subgroup analysis was performed to determine the source of heterogeneity. Data analysis was performed using Stata version 17. A P value < .05 was considered significant. Results: A total of 16,600 articles were obtained from the database search; finally, 16 articles met the inclusion criteria and were eligible for data extraction. The analysis revealed that the pooled prevalence of mortality in hospitalized COVID-19 patients was 13.9%. Advanced age was a significant risk factor for death in hospitalized COVID-19 patients, with the pooled coronavirus mortality HR and OR being 3.73 (95% CI: 2.27–5.19) and 1.04 (95% CI: 1.02–1.06), respectively. In addition, male gender (pOR 1.23; 95% CI: 1.07–1.40), patients with diabetes mellitus (DM) (pOR 1.26; 95% CI: 1.01–1.51), hypertension (HTN) (pOR 1.56; 95% CI: 1.27–1.85), chronic kidney disease (CKD) (pHR 5.43; 95% CI: 0.18–10.67), severe or critical conditions (pOR 9.04; 95% CI: 3.14–14.94) had a significantly increased risk of coronavirus-related mortality. The main limitations of the present study stem from the predominant use of published studies, which could introduce publication bias. Conclusion: According to this study, advanced age, male gender, hypertension, diabetes mellitus, chronic kidney disease, and severe or critical condition were clinical risk factors associated with death outcomes in hospitalized COVID-19 patients in Africa.