Competing Risk Survival Analysis of Time to In‐Hospital Recovery or Death Among COVID‐19 Patients: A Hospital‐Based Multicenter Retrospective Cohort Study in Southeast Ethiopia

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Background and Aims: In-hospital death and recovery are competing risks in COVID-19 patients, complicating prognosis. While international prognostic scores exist, their reliance on complex biomarkers limits their utility in resource-constrained settings. This study aimed to estimate the duration and identify determinants of in-hospital outcomes in southeast Ethiopia and to develop a clinically accessible risk stratification tool. Methods: Data from 827 confirmed COVID-19 patients (October 2022-May 2023) across six treatment centers were analyzed using the Fine-Gray Competing Risk Survival Analysis (CRSA). Additionally, a novel "Asella COVID-19 Risk Score" was developed using readily available bedside clinical parameters (age, comorbidity, and antibiotic use) and validated using receiver operating characteristic analysis. Results: = 0.014). Median time to death was 5 days. The "Asella COVID-19 Risk Score" demonstrated an area under the curve of 0.65. At an optimal cutoff of ≥ 4, the score achieved a sensitivity of 47.2%, specificity of 73.2%, and a high negative predictive value (NPV) of 83.5%. Conclusion: Advanced age and immunocompromised status significantly increase mortality risk. The Asella COVID-19 Risk Score provides a clinically validated, high-NPV triage tool suitable for resource-limited settings, facilitating the early identification of high-risk patients and more efficient resource allocation.

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