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Abstract
RÉSUMÉ
Introduction. L’Afrique a été moins touchée en termes de morbi-mortalité par la pandémie Covid-19. Certaines hypothèses et pistes explicatives ont été évoquées mais peu d’études ont été menées sur les facteurs pronostiques de la forme grave de la COVID-19 en Afrique, particulièrement en Côte d’Ivoire. L’objectif de cette étude était de décrire les facteurs associés aux décès des patients hospitalisés pour Covid-19 au service des maladies infectieuses et tropicales au CHU de Treichville à Abidjan. Méthodologie. Il s’agissait d’une étude rétrospective, monocentrique, descriptive et analytique qui s’est conduite de Mars 2020 à Février 2022 et qui a concerné les patients hospitalisés au Service des Maladies Infectieuses et Tropicales du Centre Hospitalier et Universitaire de Treichville. Résultats. Au total, 1333 patients ont été inclus dans l’étude dont 60% d’hommes soit un sex-ratio de 1,52. L’âge médian était de 55 [45-65] ans. Les comorbidités les plus retrouvées étaient l’HTA (37,6%) et le diabète (17,7%). De nos patients, 29% étaient hospitalisé en Unité de soins intensifs. Les symptômes les plus fréquents étaient la dyspnée (75%), la toux (77%) et l’asthénie (75%). On a observé une létalité hospitalière de 23%. Les facteurs associés au décès étaient : l’âge ≥ 50 ans, l’existence d’une infection au VIH, l’HTA, le diabète, la durée d’hospitalisation, la sévérité de l’infection à Covid-19 et l’admission en unité de soins intensifs. Conclusion. Les facteurs associés à une COVID-19 de mauvais pronostic sont mal connus en Côte d’Ivoire. L’âge supérieur à 50 ans, les comorbidité (HTA, le diabète et l’infection à VIH), l’admission en Unité de soins intensifs étaient les facteurs prédictifs de mortalité dans notre contexte.
ABSTRACT
Introduction. Africa has been less affected in terms of morbidity and mortality by the Covid-19 pandemic. A number of hypotheses and explanatory hypotheses have been put forward, but few studies have been conducted on the prognostic factors of the severe form of Covid-19 in Africa, particularly in Côte d'Ivoire. The aim of this study was to describe the factors associated with death in patients hospitalised for Covid-19 in the Department of Infectious and Tropical Diseases at the Treichville University Hospital in Abidjan. Methodology. This was a retrospective, monocentric, descriptive and analytical study conducted from March 2020 to February 2022 and involving patients hospitalised in the Infectious and Tropical Diseases Department of the Treichville University Hospital. Results. A total of 1333 patients were included in the study, 60% of whom were men, giving a sex ratio of 1.52. The median age was 55 [45-65] years. The most common comorbidities were hypertension (37.6%) and diabetes (17.7%). 29% were hospitalised in an intensive care unit. The most frequent symptoms were dyspnoea (75%), cough (77%) and asthenia (75%). Hospital case fatality was 23%. Factors associated with death were: age ≥ 50 years, HIV infection, hypertension, diabetes, length of hospital stay, severity of Covid-19 infection and admission to an intensive care unit. Conclusion. The factors associated with poor prognosis Covid-19 are poorly understood in Côte d'Ivoire. Age over 50 years, comorbidity (hypertension, diabetes and HIV infection) and admission to an intensive care unit were the predictive factors for mortality in our setting.
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References
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2. Radermecker C, Detrembleur N, Guiot J, Cavalier E, Henket M, d’Emal C, et al. Neutrophil extracellular traps infiltrate the lung airway, interstitial, and vascular compartments in severe COVID-19. J Exp Med 2020; 217(12): e20201012.
3. Schoneveld L, Ladang A, Henket M, Frix A-N, Cavalier E, Guiot J, et al. YKL-40 as a new promising prognostic marker of severity in COVID infection. Crit Care 2021; 25:66.
4. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected:interim guidance, 2020.
5. Williamson EJ, Walker AJ, Bhaskaran K, et al (2020) Factors associated with COVID-19-related death using OpenSAFELY. Nature 584:430–436.
6. Christiansen CF, Pottegård A, Heide-Jørgensen U, et al (2020) SARS-CoV-2 infection and adverse outcomes in users of ACE inhibitors and angiotensin-receptor blockers: A nationwide case-control and cohort analysis. Thorax 1–10
7. Mehraeen E, Karimi A, Barzegary A, Vahedi F, Afsahi AM, Dadras O, Moradmand-Badie B, Seyed Alinaghi SA, Jahanfar S (2020) Predictors of mortality in patients with COVID-19–a systematic review. Eur J Integr Med 40 :101–226.
8. Organisation Mondiale de la Santé (2020). Estimation de la mortalité due à la COVID-19, document d’information scientifique. 19:1–4.
9. Njenga MK, Dawa J, Nanyingi M, Gachohi J, Ngere I, Letko M, Otieno CF, Gunn BM, Osoro E. Why is There Low Morbidity and Mortality of COVID-19 in Africa? Am J Trop Med Hyg. 2020 Aug; 103(2):564-569. doi: 10.4269/ajtmh.20-0474. Epub 2020 Jun 1. PMID : 32484156 ; PMCID : PMC7410455.
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11. Organisation Mondiale de la Sante (2021). Prise en charge clinique Orientations évolutives COVID-19.
12. Gouvernement de la Côte d’Ivoire (2020) Côte d’Ivoire : COVID-19, Plan de riposte contre les infections respiratoires aigües à Coronavirus. 2:
13. Zhang J, Wang X, Jia X, Li J, Hu K, Chen G, Wei J, Gong Z, Zhou C, Yu H, Yu M, Lei H, Cheng F, Zhang B, Xu Y, Wang G, Dong W. Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China. Clin Microbiol Infect. 2020 Jun ;26(6) :767-772.
14. Caillard S, Anglicheau D, Matignon M, et al (2020) An initial report from the French SOT COVID Registry suggests high mortality due to COVID-19 in recipients of kidney transplants. Kidney Int 98 :1549–1558.
15. Wang, Dawei, HU, Bo, HU, Chang, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama, 2020, vol. 323, no 11, p. 1061-1069.
16. Aksel G, İslam MM, Algın A, Eroğlu SE, Yaşar GB, Ademoğlu E, Dölek ÜC (2020) Early predictors of mortality for moderate to severely ill patients with COVID-19. Am J Emerg Med 45:290–296.
17. Giacomelli A, Ridolfo AL, Milazzo L, et al (2020) 30-day mortality in patients hospitalized with COVID-19 during the first wave of the Italian epidemic: A prospective cohort study. Pharmacol Res 158:1049–31.
18. Parra-Bracamonte GM, Lopez-Villalobos N, Parra-Bracamonte FE (2020) Clinical characteristics and risk factors for mortality of patients with COVID-19 in a large data set from Mexico. Ann Epidemiol 52:93-98. e2.
19. Alkhouli M, Nanjundappa A, Annie F, Bates MC, Bhatt DL (2020) Sex Differences in Case Fatality Rate of COVID-19: Insights from a Multinational Registry. Mayo Clin Proc 95:1613–1620.
20. WU, Chaomin, CHEN, Xiaoyan, CAI, Yanping, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA internal medicine, 2020, vol. 180, no 7, p. 934-943.
21. Zhang XB, Hu L, Ming Q, Wei XJ, Zhang ZY, Chen LD, Wang MH, Yao WZ, Huang QF, Ye ZQ, Cai YQ, Zeng HQ. Risk factors for mortality of coronavirus disease-2019 (COVID-19) patients in two centers of Hubei province, China: A retrospective analysis. PLoS One. 2021 Jan 28; 16(1): e0246030. doi: 10.1371/journal.pone.0246030. PMID: 33507974; PMCID: PMC7842894.
22. Yang, Xiaobo, YU, Yuan, XU, Jiqian, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine, 2020, vol. 8, no 5, p. 475-481.
23. Gouttenoire A, Lejeune J, Redor A, Chatre C, Bertrand K, Granger C, Ferreyra M, Thevenet M, Colombain L, Aumaitre H (2020) Description et facteurs associés à la gravité d’un cluster original COVID-19. Médecine Mal Infect 50: S68–S69.
24. Ramanathan K, Antognini D, Combes A, Paden M, Zakhary B, Ogino M, Maclaren G, Brodie D (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395:497–506.
25. Bepouka B, Mayasi N, Mandina M, Longokolo M, Odio O, Mangala D, et al. Risk factors for mortality in COVID-19 patients in sub-Saharan Africa: A systematic review and meta-analysis. PLoS ONE 17(10): e0276008. https://doi. org/10.1371/journal.pone.0276008.
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