Characteristics and Factors Associated with Mortality of 200 COVID-19 Patients at a Philippine COVID-19 Tertiary Referral Center

Abstract

Objectives: To describe the clinical profile and factors associated with mortality among the first 200 patients confirmed to have COVID-19 infection admitted in the University of the Philippines – Philippine General Hospital (UP-PGH)
 Methodology: We conducted a retrospective review of adult patients with confirmed COVID-19 infection admitted in PGH, a designated COVID-19 referral center. Demographic, clinical data, and clinical outcomes were extracted from medical records. Frequencies and distributions of various clinical characteristics were described, and factors associated with mortality were investigated.
 Results: Of the 200 patients in our cohort, majority were male (55.5%), and more than half (58%) were over 60 years old. Underlying co-morbid illnesses (67.5%) included hypertension (49.5%), diabetes mellitus (26.5%), and cardiovascular disease (20.5%). Most frequent presenting symptoms were cough (69.0%), fever (58.5%), or shortness of breath (53.0%). Most patients presented with mild (n=41, 20.5%) to moderate illness (n=99, 49.5%) and only 60 were considered severely (n=32, 16.0%) or critically ill (n=28, 14.0%). Many (61%) received empiric antibiotics, while 44.5% received either repurposed drugs or investigational therapies for COVID-19. Bacterial co-infection was documented in 11%, with Klebsiella pneumoniae commonly isolated. In-hospital mortality was 17.5%, which was highest for critical COVID-19 (71.4%). Mortality was observed to be higher among patients age 60 and above, those requiring oxygen, ventilatory support and ICU admission, and among those who developed acute kidney injury, acute stroke, sepsis, and nosocomial pneumonia.
 Conclusion: Our study confirms that COVID-19 affects males, older individuals and those with underlying co-morbid conditions. Empiric antimicrobial treatment was given for majority of patients, despite documentation of bacterial infection in only 11%. K. pneumoniae was commonly isolated, reflecting local epidemiology. Mortality rate during this early period of the pandemic was high and comparable to other institutions. Factors associated with mortality were related to critical COVID-19 and are similar to other studies.

A Descriptive Study on the Clinical Profile and Outcomes of Patients with COVID-19 and Tuberculosis Co-infection

“…Although only 79 patients were included in our COVID-TB research, our study revealed worse outcomes in terms of ICU stay, proportion of patients needing invasive ventilation, and case fatality rate as well as length of hospital stay among non-survivors compared to the study of Salamat and colleagues 10 among 200 COVID-19 patients admitted in our institution ( Table 2 ). The same dismal outcomes were also demonstrated by published studies on COVID-TB.…”

“…Cardiovascular, metabolic, and respiratory comorbidities were relatively more common among COVID-19 patients especially among those with a more severe clinical course. 7 , 8 , 10 , 13 Diabetes and hypertension were isolated by earlier studies as risk factors in the development of severe to critical forms of COVID-19 and were recommended to be part of the routine screening tests. 5 , 10 Diabetes and any factor which may contribute to a poor immune system of an individual, like HIV, may also pose significant risks in the pathogenesis of TB.…”

“… 7 , 8 , 10 , 13 Diabetes and hypertension were isolated by earlier studies as risk factors in the development of severe to critical forms of COVID-19 and were recommended to be part of the routine screening tests. 5 , 10 Diabetes and any factor which may contribute to a poor immune system of an individual, like HIV, may also pose significant risks in the pathogenesis of TB. 4 It is therefore expected that individuals with both COVID and TB may harbor such comorbid conditions.…”

“…Our study also compared the outcomes to a published study done by Salamat, et al 10 Their study included the first 200 adult patients aged 19 years old and above, with RT-PCR-confirmed COVID-19, admitted at UP-PGH from March 12, 2020, to April 28, 2020. They employed a descriptive retrospective cohort design.…”

Predictors and Outcomes of Hospitalized COVID-19 Patients with Liver Injury

“…14 COVID-19 was classified as mildpatients with symptoms of COVID-19 without pneumonia; moderate -patients with clinical and radiographic evidence of pneumonia but not requiring oxygen; severe -patients with clinical and radiographic evidence of pneumonia with oxygen saturation <92% on room air and requiring oxygen support; critical -patients with ARDS, septic shock, requiring mechanical ventilation and admission to the intensive care unit (ICU) or both. 14,15 For this study, liver injury (LI) was defined as an elevation of ALT above the upper limit of normal (normal value was based on the institutional cut-off of 50 u/L) at any time during admission. ALT was chosen over AST because it is more specific to the liver.…”