Hussain Alkhalifa ¹ Ehab Darwish ^2,3 Zaenb Alsalman ^4* Aman Alfaraj ¹ Abdullah Alkhars ⁵ Fatimah Alkhalifa ⁶ Mohammed Algaraash ⁷ Ahmed Mohammed Elshebiny ^8,9 Emad Alkhoufi ³ Khaled Mohamed Amin Elzorkany ^10,3

• ¹ Internal Medicine Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
• ² Tropical Medicine Department, College of Medicine, Zagazig University,, Zagazig, Egypt
• ³ Internal Medicine Department, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
• ⁴ Department of Family and Community Medicine, College of Medicine, King Faisal University, Al-Ahsa, Eastern Province, Saudi Arabia
• ⁵ Neonatal Intensive Care Unit, Department of Paediatrics, Maternity and Children Hospital, Al-Ahsa, Saudi Arabia
• ⁶ Pathology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
• ⁷ Internal Medicine Department, Prince Saud Bin Jalawi Hospital, Al-Ahsa, Saudi Arabia
• ⁸ Division of Endocrinology and Diabetes, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
• ⁹ Diabetes and Endocrinology Unit, College of Medicine, Menoufia University, Menoufia, Egypt
• ¹⁰ Internal Medicine Department, College of Medicine, Menoufia, Egypt

Background: COVID-19 poses a significant threat to global public health. As the severity of SARS-CoV-2 infection varies among individuals, elucidating risk factors for severe COVID-19 is important for predicting and preventing illness progression, as well as lowering case fatality rates. This work aimed to explore risk factors for developing severe COVID-19 to enhance the quality of care provided to patients and to prevent complications.Methods: A retrospective study was conducted in Saudi Arabia's eastern province, including all COVID-19 patients aged 18 years or older who were hospitalized at Prince Saud Bin Jalawi Hospital in July 2020. Comparative tests as well as both univariate and multivariate logistic regression analyses were performed to identify risk factors for developing severe COVID-19 and poor outcomes.Based on the comparative statistical tests patients with severe COVID-19 were statistically significantly associated with older age and had higher respiratory rate, longer hospital stay, and higher prevalence of diabetes than non-severe cases. They also exhibited statistically significant association with high levels of potassium, urea, creatinine, lactate dehydrogenase (LDH), D-dimer, and aspartate aminotransferase (AST). The univariate analysis shows that having diabetes, having high severe acute respiratory infection chest X-ray scores, old age, prolong hospitalization, high potassium and lactate dehydrogenase, as well as using insulin, heparin, corticosteroids, favipiravir or azithromycin were all statistically significant associated with severe COVID-19. However, after adjustments in the multivariate analysis, the sole predictor was serum LDH (P = 0.002; OR 1.005; 95% CI 1.002-1.009). In addition, severe COVID-19 patients had higher odds of being prescribed azithromycin than non-severe patients (P = 0.001; OR 13.725; 95% CI 3.620-52.043). Regarding the outcomes, the median hospital stay duration was statistically significantly associated with death, intensive care unit admission (ICU), and mechanical ventilation. On the other hand, using insulin, azithromycin, beta-agonists, corticosteroids, or favipiravir were statistically significantly associated with reduced mortality, ICU admission, and need of mechanical ventilation.This study sheds light on numerous parameters that may be utilised to construct a prediction model for evaluating the risk of severe COVID-19. However, no protective factors were included in this prediction model.