In-Hospital Mortality Predictors among COVID-19 Patients in the West Bank, Palestine: A Multi-Center Retrospective Cohort Study

Hamzeh Al Zabadi^1,2*Danyah Khalid¹Ibrahim Taha^3*Mohammed Rabae⁴Jamal Qaddumi⁵

• ¹Master of Public Health Management, faculty of graduate studies, An-Najah National University, Nablus, Palestine
• ²An-najah National University Faculty of Medicine and Health Sciences, Nablus, Palestine
• ³Optometry Department, Arab American University, Ramallah,, Palestine
• ⁴Dura Governmental Hospital, Palestinian Ministry of Health, Hebron, Palestine
• ⁵Department of Nursing, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine

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.