Browsing by Author "Fleischer, Brian"
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Item High Mortality During the Second Wave of the Coronavirus Disease 2019 (COVID-19) Pandemic in Uganda: Experience From a National Referral COVID-19 Treatment Unit(Open Forum Infectious Diseases, 2021) Bongomin, Felix; Fleischer, Brian; Olum, Ronald; Natukunda, Barbra; Kiguli, Sarah; Byakika-Kibwika, Pauline; Baruch Baluku, Joseph; Nakwagala, Frederick NelsonWe evaluated clinical outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in the second wave of the pandemic in a national COVID-19 treatment unit (CTU) in Uganda. Methods. We conducted a retrospective cohort study of COVID-19 patients hospitalized at the Mulago National Referral Hospital CTU between May 1 and July 11, 2021. We performed Kaplan-Meier analysis to evaluate all-cause in-hospital mortality. Results. Of the 477 participants, 247 (52%) were female, 15 (3%) had received at least 1 dose of the COVID-19 vaccine, and 223 (46%) had at least 1 comorbidity. The median age was 52 (interquartile range, 41–65) years. More than 80% of the patients presented with severe (19%, n = 91) or critical (66%, n = 315) COVID-19 illness. Overall, 174 (37%) patients died. Predictors of all-cause in-hospital mortality were as follows; age ≥50 years (adjusted odds ratio [aOR], 1.9; 95% confidence interval [CI], 1.2–3.2; P = .011), oxygen saturation at admission of ≥92% (aOR, 0.97; 95% CI, 0.91–0.95; P < .001), and admission pulse rate of ≥100 beats per minute (aOR, 1.01; 95% CI, 1.00–1.02; P = .042). The risk of death was 1.4-fold higher in female participants compared with their male counterparts (hazards ratio, 1.4; 95% CI, 1.0–2.0; P = .025). Conclusions. In this cohort, where the majority of the patients presented with severe or critical illness, more than one third of the patients hospitalized with COVID-19 at a national CTU died of the illness.Item Higher intensive care unit consultations for COVID-19 patients living with HIV compared to those without HIV co-infection in Uganda.(Journal of Medical Virology, 2022) Fleischer, Brian; Olum, Ronald; Nakwagala, Frederick Nelson; Rhodah Nassozi, Dianah; Pitua, Ivaan; Paintsil, Elijah; Baruch Baluku, Joseph; Bongomin, FelixCoronavirus disease-2019 (COVID-19) is the leading cause of death worldwide from a single infectious agent. Whether or not HIV infection affects clinical outcomes in patients with COVID-19 remains inconclusive. This study aimed to compare the clinical outcomes of people living with HIV (PLWH) and non-HIV-infected patients hospitalized during the second wave of the COVID-19 pandemic in Uganda. Methods: We retrospectively retrieved data of patients with COVID-19 who were admitted to the Mulago National Referral Hospital in Uganda between April 2021 and mid-July 2021. We performed propensity-score-matching of 1:5 to compare outcomes in COVID-19 patients living with and those without HIV co-infection (controls). Results: We included 31 PLWH and 155 non-HIV controls. The baseline characteristics were similar across groups (all p values > 0.05). PLWH had close to 3-fold higher odds of having ICU consultation compared to controls ([OR]: 2.9, 95% CI: 1.2 – 6.9, p=0.015). There was a trend towards having a severe or critical COVID-19 illness among PLWHIH compared to controls (odds ratio [OR]: 1.9, 95% CI: 0.8 – 4.7, p=0.164). Length of hospitalization was not significantly different between PLWH and non-HIV controls (6 days for vs. 7 days, p=0.184). Seven-day survival was 63% (95% CI: 42% – 78%) among PLWH and 72% (95% CI: 61% – 82%) among controls while 14-day survival was 50% (95% CI: 28% – 69%) among PLWH and 65% (95% CI: 55% – 73%) among controls (p=0.280). There was another trend towards having 1.7-fold higher odds of mortality among PLWH compared to controls ([OR]: 1.7, 95% CI: 0.8 – 3.8, p=0.181). Conclusions: Our data suggests that PLWH may be at an increased risk of severe or critical COVID-19 illness requiring ICU consultation. Further studies with larger sample sizes are recommended.