Risk factors of COVID-19 mortality in Morocco: A retrospective cohort study (Preprint)

BACKGROUND Since reporting the first Sars-cov-2 infection cases in China, a national monitoring and response plan was developed and implemented in Morocco. The first COVID-19 case was detected in Morocco on 03/02/2020 and a several response measures were implemented. The scientific advisory committee set up therapeutic protocols for managing COVID-19 cases on 03/21/2020 that were used to treat all patients in public and private hospitals. OBJECTIVE To research associated factors with COVID-19 mortality in Morocco before and after the protocols adoption. METHODS We conducted a retrospective cohort study. We used the COVID-19 national epidemiological surveillance database, from March 2 to May 10. We focused only on confirmed cases of COVID-19, defined as any person with RT-PCR positive SARS-CoV-2. Two periods were defined according to the therapeutic protocols implementation in Morocco. The dependent variable was the outcome of COVID-19 patients. A logistic regression, using the Epi-info software (V 7.2), was performed to explain the outcome by the different explanatory variables: gender, age, comorbidities, clinical status at admission. The adjusted Odds Ratio for all variables used in the model were presented with their 95% confidence intervals. RESULTS From March 02 to May 10, Morocco registered 6072 cases of COVID-19; 14.1% (855) were registered before the therapeutic protocol implementation and 85.9% (5217) after. 56.1% (3409) patients were male, 91.4% (5449) were under the age of 65, only 2.7% (95) were admitted at a critical or severe clinical stage and 6.0% (366) had one or more comorbidities. The case fatality rate was 3.14% (191). Male gender (ORa=1.61; 95%CI: 1.01-2.58), age >65 years (ORa=4.69; 95%CI: 2.87-7.67), critical or severe status at admission (ORa=19.55; 95%CI: 11.12-34.38) and the presence of comorbidity (ORa=3.33; 95%CI: 2.00-5.53) were associated with death. The death risk after the protocols implementation was lower (ORa=0.22; 95%CI: 0.14-0.35). CONCLUSIONS To reduce mortality risk, the therapeutic protocols and early COVID-19 detection should be maintained to avoid severe forms, especially in the elderly and subjects with comorbidity. CLINICALTRIAL NA