Clinical Characteristics and Prognosis of COVID-19 patients in Syria: A cross-sectional multicenter study

Hasan Nabil Al Houri; Heba Al-Tarcheh; Ebtesam Zahra; Ammar Al-Tarcheh; Humam Armashi; Marwan Alhalabi

doi:10.1016/j.amsu.2022.103816

Clinical Characteristics and Prognosis of COVID-19 patients in Syria: A cross-sectional multicenter study

Ann Med Surg (Lond). 2022 Jun:78:103816. doi: 10.1016/j.amsu.2022.103816. Epub 2022 May 21.

Authors

Hasan Nabil Al Houri^{1

2

3}, Heba Al-Tarcheh⁴, Ebtesam Zahra⁵, Ammar Al-Tarcheh⁶, Humam Armashi⁷, Marwan Alhalabi⁸

Affiliations

¹ Internal Medicine Department, Al Assad University Hospital, AL Mouwasat University Hospital, Damascus, Syria.
² Internal Medicine Department, Syrian Private University, Damascus, Syria.
³ Internal Medicine Department, Al-Sham Private University, Damascus, Syria.
⁴ Department of Pulmonary Medicine, Al Assad University Hospital, Damascus, Syria.
⁵ Internal Medicine Department, Al Assad University Hospital, Damascus, Syria.
⁶ Gastroenterology Department, Al Assad University Hospital, And AL Mouwasat University Hospital, Damascus, Syria.
⁷ Internal Medicine Department, Syrian Private University (SPU), Syria.
⁸ Department of Reproductive Medicine, Genetics and Embryology, Faculty of Medicine, Damascus University, Damascus, Syria.

Abstract

Background: COVID-19 ignited a global pandemic that, in Syria, further strained a nation and its healthcare system already ravaged by years of war and sanctions. The first case in Syria was reported on March 22, 2020, and this is the first study that aimed to describe the clinical characteristics, comorbidities, and prognosis of COVID-19 patients in Syria.

Materials and methods: Demographic and clinical data for this cross-sectional prospective study were collected on COVID-19 patients with positive polymerase chain reaction tests who were admitted to Al Assad and Al Mouwasat university hospitals between April 1 and January 31 of 2021.

Results: This study included 701 patients. The majority were over age 60 (59%) and male (67.9%). The commonest symptoms were fever (86.6%) and shortness of breath (75.6%). The commonest comorbidities were hypertension (53.9%) and diabetes mellitus (41.5%). On multivariable analysis, risk factors found to be significantly associated with poor outcomes were advanced age (≥60 years); male gender; high respiratory rate (>35); respiratory failure (PaO₂/FiO₂ ratio<100); heart failure; chronic lung disease; elevated white blood cell counts, lactate dehydrogenase, c-reactive protein; prolonged international normalized ratio; and low lymphocyte counts. The clinical outcomes of our patients were as follows: 59.2% improved and were discharged from the hospital, 3.5% were discharged with persistent symptoms and 37.2% died.

Conclusion: Several biomarkers can serve as early warning and prognostic indicators of severe illness and mortality from COVID-19 in the highest risk patients, especially males with multiple comorbidities over 60 years of age. In the context of a national healthcare system stretched thin by years of civil war and sanctions, and high COVID-19 mortality rates as a consequence, extra care should be taken to use the predictive power of these biomarkers to stratify high-risk patients in the earliest possible stages of the disease to minimize severe illness and reduce fatalities.

Keywords: COVID-19; Clinical characteristics; Prevalence; Prognosis; Syria.