# In-hospital mortality predictors among COVID-19 patients in the West Bank, Palestine: a multi-center retrospective cohort study

## TL;DR

This study identifies obesity, hospital type, and certain treatments as key predictors of in-hospital mortality among COVID-19 patients in the West Bank, Palestine.

## Contribution

The study provides novel insights into mortality predictors specific to the Palestinian healthcare context during the early stages of the pandemic.

## Key findings

- Obesity was the strongest predictor of mortality (OR = 5.73, p < 0.001).
- Actemra (tocilizumab) use was associated with significantly lower mortality (0% vs. 46%).
- Hospital type was an independent predictor, with Dura Hospital showing higher mortality odds (OR = 3.26).

## Abstract

COVID-19 pandemic has presented unprecedented challenges to global healthcare systems, particularly in resource-limited settings like Palestine. Identifying clinical, demographic, and laboratory predictors of in-hospital mortality is crucial for improving outcomes, guiding treatment, and optimizing resource allocation.

This study aimed to determine the key demographic, clinical, laboratory, and treatment-related factors associated with in-hospital mortality among COVID-19 patients admitted to six governmental hospitals across the West Bank, Palestine.

A retrospective cohort design was employed using data from 200 confirmed COVID-19 patients hospitalized between November 1, 2020, and February 1, 2021. Bivariate analyses were conducted using Chi-square and t-tests. Statistically significant variables (p < 0.05) were entered into logistic and Cox regression models to identify independent predictors of mortality and time to death.

The overall In-hospital mortality rate was 43%. Obesity was the strongest predictor of mortality (OR = 5.73, p < 0.001; HR = 2.66, p < 0.001). Pregnant women showed alarmingly high mortality (81%), though this did not remain significant in multivariate analysis due to small sample size. Widowed patients were significantly more likely to die (HR = 2.77, p = 0.019), emphasizing the role of social support. Hospital type was another independent predictor, with patients at Dura Hospital experiencing higher odds of death (OR = 3.26, p = 0.017). Key laboratory findings included significantly lower PaO2, serum creatinine, and random blood sugar levels among non-survivors. Actemra (tocilizumab) use was associated with significantly lower mortality (0% vs. 46%, p = 0.001), while vancomycin and ceftriaxone were associated with higher mortality, likely reflecting use in severe cases.

This study identified key predictors of COVID-19 mortality in Palestine, emphasizing the need to prioritize high-risk groups such as obese and pregnant patients. The findings highlight disparities between hospitals and reinforce the importance of standardizing care across healthcare facilities. These insights can help shape evidence-based health policies tailored to the Palestinian context and could serve as a foundational dataset for preparedness in future pandemics or resurgences of COVID-19.