RETROSPECTIVE ANALYSIS OF MORTALITY DETERMINANTS IN COVID-19 PATIENTS BASED ON CLINICAL DIAGNOSES PRIOR TO DEATH AT A NATIONAL REFERRAL HOSPITAL IN INDONESIA

Abstract

Background: Mortality in COVID-19 patients is often the result of multiple overlapping clinical complications rather than a single cause. Understanding these patterns is essential for improving clinical outcomes and supporting accurate forensic evaluation.  Aim: This study aimed to identify the clinical conditions contributing to death in COVID-19 patients and to assess the association between the number of co-occurring conditions and patient outcomes.  Methods: A retrospective observational study was conducted on 100 confirmed COVID-19 patients admitted to a national referral hospital in Indonesia. Data on demographic characteristics, comorbidities, clinical severity, and outcomes were collected from medical records. Clinical causes of death were recorded and categorized by the number of co-occurring conditions. Unadjusted and adjusted odds ratios (ORs) for mortality were calculated using logistic regression, adjusting for age, sex, BMI, comorbidities, and disease severity.  Results: The most frequently documented clinical conditions contributing to death were acute respiratory distress syndrome (68%), respiratory failure (55%), and septic shock (34%). Among patients, 30% had one condition, 45% had two, and 25% had three or more. Compared to patients with a single condition, those with two conditions had an adjusted OR of 2.41 (95% CI: 1.16–4.41), and those with three or more conditions had an adjusted OR of 19.4 (95% CI: 10.73–32.23).  Conclusion: Mortality in COVID-19 is significantly associated with the number of co-occurring clinical conditions. Early detection and integrated management of overlapping complications are essential for reducing fatal outcomes and improving diagnostic accuracy in clinical and forensic settings.