Predictors of In-Hospital Mortality in COVID-19-Associated Hospital-Acquired Pneumonia: Experience from a Tertiary Care Hospital
Keywords:
COVID-19, Hospital-Acquired Pneumonia, Mortality, Inflammatory MarkersAbstract
Background: COVID-19 has significantly increased the risk of hospital-acquired pneumonia (HAP), especially in critically ill patients. The overlap of viral and secondary bacterial infections contributes to increased morbidity and mortality. Identifying key predictors of in-hospital mortality in such patients is essential for improving clinical outcomes and guiding targeted interventions. Objective: To identify and evaluate the clinical, laboratory, and microbiological factors associated with in-hospital mortality among patients diagnosed with COVID-19-associated hospital-acquired pneumonia (HAP) in a tertiary care setting. Methodology: A retrospective observational analysis was performed on 110 adult COVID-19 patients who had HAP ≥48 hours after hospitalization during the period from January 2023 to December 2023. Demographic, clinical, laboratory, and microbiological information were compared between non-survivors and survivors. Statistical significance was evaluated by using appropriate univariate tests. Results: Mortality was strongly correlated with advanced age (p = 0.01), chronic kidney disease (p = 0.01), ICU stay (p < 0.001), and mechanical ventilation (p < 0.001). Non-survivors had highly raised inflammatory and renal markers: ferritin >1000 µg/mL (p < 0.001), D-dimer >1.3 mg/L (p = 0.01), procalcitonin >2.0 ng/mL (p < 0.001), and creatinine >1.3 mg/dL (p = 0.001). Aspergillus species were much more frequent among non-survivors (31.8% vs. 12.1%, p = 0.05), indicating an association with higher mortality from invasive fungal infections. Conclusion: Advanced age, renal impairment, ICU-level treatment, mechanical ventilation, high inflammatory markers, and Aspergillus coinfection are major mortality predictors in COVID-19 patients with hospital-acquired pneumonia. These results underscore the need for earlier risk stratification, fungal diagnostics, and early intervention to minimize mortality in resource-constrained environments.References
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