Clinical characteristics and clinical predictors of mortality in hospitalised patients of COVID 19 : An Indian study

Abstract

Background The rapid spread of the coronavirus disease 2019 (COVID-19) with high mortality rate necessitates disease characterization and accurate prognostication for prompt clinical decision-making. The aim of this study is to study clinical characteristics and predictors of mortality in hospitalized patients with COVID-19 in India. Methods Retrospective cohort study was conducted in a tertiary care hospital in northern India. All consecutive confirmed hospitalized COVID-19 cases aged 15 years and older from 13 Apr till 31 Aug 2020 are included. Primary end point was 30-day mortality. Results Of 1622 patients ,1536 cases were valid. Median age was 36 years, 88.3% were men and 58.1% were symptomatic. Fever (37.6%) was commonest presenting symptom. Dyspnea was reported by 15.4%. Primary hypertension (8.5%) was commonest comorbidity, followed by diabetes mellitus (6.7%). Mild, moderate, and severe hypoxemia were seen in 3.4%, 4.3%, and 0.8% respectively. Logistic regression showed greater odds of moderate/severe disease in patients with dyspnea, hypertension, Chronic Kidney Disease (CKD), and malignancy. Seventy six patients died (4.9%). In adjusted Cox proportional hazards model for mortality, patients with dyspnea (hazard ratio [HR]: 14.449 [5.043-41.402]), altered sensorium (HR: 2.762 [1.142-6.683]), Diabetes Mellitus (HR: 1.734 [1.001-3.009]), malignancy (HR:10.443 [4.396-24.805]) and Chronic Liver Disease (CLD) (HR: 14.432 [2.321-89.715]) had higher risk. Rising respiratory rate (HR: 1.098 [1.048-1.150]), falling oxygen saturation (HR: 1.057 per unit change 95% CI: 1.028-1.085) were significant predictors. Conclusion Analysis suggests that age, dyspnea, and malignancy were associated with both severe disease and mortality. Diabetes Mellitus and Chronic Liver Disease were associated with increased the risk of fatal outcome. Simple clinical parameters such as respiratory rate and oxygen saturation are strong predictors and with other risk factors at admission can be effectively used to triage patients.

Diagnostic Value of C-Reactive Protein, Albumin, and the CRP-to-Albumin Ratio for Predicting Mortality in Hospitalized Patients with COVID-19 in Brazilian hospitals

“…Notably, the demographic, clinical, and comorbidity profile of the patients analyzed in this study was similar to that observed in other studies on hospitalized patients with COVID-19 [2,27,28]. International and Brazilian studies have shown that the presence of comorbidities such as hypertension, diabetes mellitus, and obesity increases the risk of death among patients with COVID-19 [1,2]. In this study, the most common comorbidity was hypertension, followed by diabetes mellitus, obesity, and cardiovascular disease.…”

“…Notable symptoms include cough, sore throat, runny nose, nasal congestion, anosmia, ageusia, diarrhea, abdominal pain, fever, chills, headache, and myalgia. The inflammatory process that develops in the early stages of the disease, can leads to progressive worsening of respiratory symptoms, which can progress to pneumonia with dyspnea, fatigue, and hypoxemia [2].…”

Vaccination saves lives: How do patients with chronic diseases and severe COVID-19 fare? Analysis from India’s National Clinical registry for COVID-19

“…16 Diabetes causes an inhibition in neutrophil chemotaxis, phagocytosis, and intracellular destruction of microbes, thus offering efficient virus entry and decreased viral clearance. 17 In our study, patients above 40 years of age had 1.3 times higher adjusted odds of dying than the younger patients, which increased to 2.1 time with advanced age ≥ 60 year. Advanced age, especially ≥ 60 year, is an established independent risk factor for dying in COVID-19 patients, as shown in various studies across multiple countries since the onset of the pandemic.…”

“…16 Diabetes causes an inhibition in neutrophil chemotaxis, phagocytosis, and intracellular destruction of microbes, thus offering efficient virus entry and decreased viral clearance. 17…”

Clinical Outcomes and Direct Medical Expenditures Associated With Intensive Care Unit Admission for Inpatients With COVID-19 in Jordan: A Retrospective Cohort Study

“…In India, age, dyspnea, and the presence of comorbid diseases such as malignancy and DM were significantly associated with increased mortality. 27 In the nearby regions, age and some biochemical and vital measures were associated with mortality in United Arab Emirates. 16 End-stage renal disease was also observed as a significant predictor of mortality among patients with COVID-19 in Saudi Arabia.…”