Clinical Characteristics and Risk Factors for Severity of COVID-19 Infections in Malaysia

Background: COVID-19 emerged as a major public health outbreak in China in late 2019. Malaysia reported its first imported case on 25 January 2020, and adopted a policy of extensive contact tracing and hospitalizing of all patients, regardless of severity. We describe clinical characteristics of COVID-19 patients nationwide and determine the risk factors associated with disease severity. Method: Clinical records of all RT-PCR confirmed COVID-19 patients admitted to 18 designated hospitals in Malaysia between 1 February and 30 April 2020 with complete outcomes were retrieved. Epidemiological history, co-morbidities, clinical features, investigations, management and complications were captured using REDCap database. Variables were compared among patients with mild and severe diseases. Univariate and multivariate regression analyses were used to identify determinants for disease severity. Findings:The sample comprised of 5889 cases (median age 34 years, male 71·7%). Majority were mild (92%) and 3·3% required intensive care with 80% admitted within the first 5 days. Older age (> 51 years), fever, cough, diarrhoea, breathlessness, tachypnoea, abnormal chest radiographs and high serum CRP (≥5mg/dL) on admission were significant determinants for disease severity (p < 0·05). The case fatality rate was 1·2% and the three commonest complications were liver injuries (6·7%), kidney injuries (4%), and acute respiratory distress syndrome (2·3%). Interpretations: Lower case fatality rate was contributed by young patients with mild presenting COVID-19 and early hospitalisation. Abnormal chest radiographic findings in symptomatic elderly with tachypnoea require close monitoring in first 5 days to detect early deterioration. Funding Statement: Supported by NIH, Malaysia Declaration of Interests: None to declare. Ethics Approval Statement: The study was registered with the National Medical Research Register (NMRR-20-580- 54339) and approved by the Medical Research and Ethics Committee, Ministry of Health, Malaysia (KKM/NIHSEC/P20-706).