How do Individual Risk Factors Affect the Progression of COVID-19 in Iran? A Multi-State Model Approach
نویسندگان
1 Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
2 Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
3 Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
4 Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
5 Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
doi
10.22034/ircmj.2025.463960.1258چکیده
Background and Objectives: The COVID-19 pandemic has significantly impacted global health systems, placing immense pressure on intensive care units (ICUs). Understanding the associated risk factors of ICU hospitalization, discharge, and mortality in COVID-19 patients is crucial for improving patient care. This article investigates the population-based incidence of hospitalization in ICU, discharge, mortality, and relevant risk factors in COVID-19 patients. Methods: This retrospective cohort study conducted on COVID-19 patients referred to Masih Daneshvari Hospital in Tehran from April to November 2021. Multi-state models used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for potential risk factors in five transitions: Hospital admission to ICU (I), Hospital admission to discharge (II), Hospital admission to mortality (III), ICU to discharge (IV), and ICU to mortality (V). Results: The results, which included 442 COVID-19 patients, showed that diastolic blood pressure (DBP), phosphorus, and respiratory rate intensified transition rate I by 2% (HR=1.02, 95%CI:(1.00,1.04)), 25% (HR=1.25, 95%CI:(1.01,1.54)), and 9% (HR=1.09, 95%CI:(1.03,1.16)), respectively. Aging had a protective effect by 21% (HR=0.79, 95%CI:(0.63,0.98)) in transition rate II. An increase in Calcium level intensified transition rate IV by 77% (HR=1.77, 95%CI:(1.05,2.71)). Aging, creatinine, and uric acid increased the hazard ratio of transition V by 2.61 (HR=2.61, 95%CI:(1.28,5.32)), 2.13 (HR=2.13, 95%CI:(1.19,3.79)), and 1.2 times (HR=1.20, 95%CI:(1.04,1.38)), respectively. Conclusion: DBP, phosphorus, and respiratory rate intensified ICU admission rates, aging decreased hospital discharge rates, while creatinine and uric acid were linked to higher ICU mortality in COVID-19 patients. These findings offer valuable insights for improving patient care and ICU resource management.
