Prevalence and predictors of critical COVID-19 pneumonia among patients with COVID-19 admitted at Nyarugenge major COVID-19 Referral Center in Rwanda.

BACKGROUND: Coronavirus Disease 2019(COVID-19) pneumonia, caused by the Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2 virus), remains a significant global health challenge, contributing to millions of cases and deaths worldwide, including a substantial burden in Rwanda. Severe and critical cases often lead to respiratory failure, multi-organ dysfunction, and increased mortality. Despite global research, data on predictors of critical illness among hospitalized COVID-19 patients in Rwanda remain limited, highlighting the need for context-specific studies. This study aimed to assess the prevalence and identify risk factors for critical COVID-19 pneumonia among patients admitted to the Nyarugenge Major COVID-19 Referral Center in Rwanda. METHODS: A mixed-study design combining retrospective and prospective designs was conducted from February to October 2021, and we included 320 patients aged 15 to 65 years admitted with severe or critical COVID-19 pneumonia. Data were collected on socio-demographic factors, vital signs, and clinical symptoms. Multivariate logistic regression was performed using Stata 17 to identify independent predictors of critical illness. RESULTS: Of the 320 patients, 30% presented with critical illness, while 70% had severe illness. Independent predictors of critical illness included oxygen saturation ≤ 90% {Adjusted Odds Ratio (AOR) = 5.83, 95% Confidence Interval(CI): 2.95-11.52, p < 0.001), respiratory rate > 20 beat per minute(bpm), (AOR = 2.34, 95% CI: 1.11-4.93, p < 0.05), and heart rate > 100 bpm (AOR = 2.49, 95% CI: 1.32-4.67, p < 0.01). CONCLUSIONS: Critical illness was prevalent in 30% of patients, with hypoxia, tachypnea, and tachycardia as significant predictors. These findings identify key clinical predictors of critical COVID-19 pneumonia and suggest that monitoring these indicators may help guide early intervention and optimize resource allocation in Rwanda and similar low- and middle-income settings. CLINICAL TRIAL NUMBER: Not applicable.