Exploring the relationship between SARS‐CoV‐2 variants, illness severity at presentation, in‐hospital mortality and COVID‐19 vaccination in a low middle‐income country: A retrospective cross‐sectional study

Author:

Mushtaq Muhammad Zain1ORCID,Nasir Nosheen1ORCID,Mahmood Syed Faisal1,Khan Sara1,Kanji Akbar2ORCID,Nasir Asghar2,Syed M. Asif3,Aamir Uzma Bashir4,Hasan Zahra2ORCID

Affiliation:

1. Department of Medicine The Aga Khan University Karachi Pakistan

2. Department of Pathology and Laboratory Medicine The Aga Khan University Karachi Pakistan

3. Department of Health Government of Sindh Hyderabad Pakistan

4. Country Office World Health Organization Islamabad Pakistan

Abstract

AbstractBackground and AimsCOVID‐19 morbidity and mortality varied globally through the pandemic. We studied the relationship of SARS‐CoV‐2 variants of concern (VOC) with COVID‐19 severity and mortality among hospitalized patients in Pakistan.MethodsA retrospective review of clinical, laboratory, and vaccination data of 197 COVID‐19 adult patients at the Aga Khan University Hospital, Karachi between April 2021, and February 2022 was performed. SARS‐CoV‐2 VOC identified in respiratory samples were analyzed. Univariate and multivariate analysis was conducted to identify factors associated with COVID‐19 outcomes.ResultsThe median age of cases was 55 years and 51.8% were males. Twenty‐four percent of females were pregnant. Of COVID‐19 cases, 48.2% had nonsevere disease, while 52.8% had severe/critical disease. Hypertension (48%) and diabetes mellitus (41%) were common comorbids. SARS‐CoV‐2 VOC identified comprised; Omicron (55.3%), Beta (14.7%), Alpha (13.7%), Delta (12.7%), and Gamma (3.6%) variants. Most (59.7%) study subjects were unvaccinated. Of vaccines, 88% had received inactivated virus COVID‐19 vaccines. Increased risk of severe disease was associated with age ≥50 years (odds ratio [OR]: 5.73; 95% confidence interval [CI]: [2.45–13.7]), as well as with diabetes mellitus (OR: 4.24; 95% CI: [1.82–9.85]). Full vaccination (OR: 0.25; 95% CI: [0.11–0.58]) or infection with Omicron (OR: 0.42; 95% CI: [0.23–0.74]) was associated with reduced disease severity. The risk of mortality increased with age ≥50 years (OR: 5.07; 95% CI: [1.92–13.42]) and a history of myocardial infarction (OR: 5.11; 95% CI: [1.45–17.93]) whilst, infection with Omicron was found to reduce the risk (OR: 0.22; 95% CI: [0.10–0.53]).ConclusionOur study describes the relationship between the severity of COVID‐19, in‐hospital mortality in relation to SARS‐CoV‐2 variants, and the impact of COVID‐19 vaccination in Pakistan. Outcomes were more favorable in younger individuals, after vaccinations and with Omicron variant infections. Most cases received inactivated virus vaccines therefore these data highlight the protection provided against severe COVID‐19.

Funder

Higher Education Commision, Pakistan

Publisher

Wiley

Subject

General Medicine

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