Risk factors contributing to the Mortality in Middle East Respiratory Coronavirus Patients

Purpose: To investigate the prevalence of risk factors associated with the Middle East respiratory Syndrome (MERS) coronavirus and quantify the relative hazard of death attributed to some selected risk factors among the confirmed patients reported by the World Health Organization (WHO). On reviewing the literature we identified four risk factors (consumption of unpasteurized camel milk, visiting camel farm, working at health care facility, and or having the co-morbid condition). These risk factors are associated with mortality among the MERS-coronavirus cases. The main objective is to quantify the relationship between the risk of death and these risk factors using survival analytic models. Methods: We collected data available on the WHO web-site for reported cases who have complete information on date of admission to health care facility, data last seen, status on this date (dead or alive), gender, age, country of reporting, together with complete information on whether a reported case consumed unpasteurized dairy product, visited camel farm, working at a health care facility and potentially contacted an infected person, and or having comorbid condition. Complete data was available for 841 coronavirus patients and 274 associated deaths. Chi-square test for trend, independent samples t-test and survival analyses using Cox regression models are used to identify the relative hazard of death attributed to these suspected risk factors, after adjusting for the potentially confounding effect of age and gender. Results: From June 2012 to July 2016,841 MERS coronavirus patients we included cases with complete information on age (54.36 ± 0.697), sex (male to female ratio 2.58:1), admission date to a health care facility, date last seen, giving median survival time 5 days (range from 0 to 63 days).The presence of comorbidity (0.26 ± 0.017), visiting camel farm (0.32 ± 0.018) consuming camel farm unpasteurized dairy product (0.32 ± 0.018), and working in a health care facility (0.11 ± 0.012) were analyzed. Only age, the presence of co-morbid condition and being a health care facility worker were significantly correlated with death. It is interesting to see that working in health care facility was significantly correlated with the hazard of death but it had a sparing effect because most of the health care workers were young. The mean age of health care workers who were infected with the coronavirus was 40.17 ± 13, and the mean age of those who were infected but did not work in a health care facility was 56.22 ± 18. Conclusion: We show that being old (age above 66 years of age), the presence of co-morbid conditions, and visiting camel farms and consumption of unpasteurized dairy product contributed significantly to the hazard of death among the MERS-CoV patients. Apart from age, all the risk factors that contribute to mortality are modifiable and their impact on mortality may significantly be reduced when individual patients adhere to infection control measures.