Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients in a MERS-CoV Endemic Area

Abstract

Background: The Kingdom of Saudi Arabia (KSA) reported 170,639 cases and 1430 deaths from COVID-19 since the first case emerged in the country on March 2 through June 25, 2020. The objective of this report is to describe the characteristics and outcome observed among 99 hospitalized COVID-19 patients in the largest academic hospital in KSA, and assess co-infection with the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Methods: This single-center case series data included select epidemiological, clinical, radiological features and laboratory findings of all confirmed hospitalized cases of COVID-19 in King Saud University Medical City (KSUMC), Riyadh, KSA, from March 22 until May 31, 2020, followed through June 6, 2020. We conducted retrospective analysis of listed data from 99 hospitalized patients and present characteristics and factors associated with severity in percentages and univariate odds ratios. Cases were confirmed using nasopharyngeal or throat swab by real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and MERS-CoV by RT-PCR. Results: The 99 hospitalized COVID-19 patients included in this analysis constitute 16% of 632 positive SARS-CoV-2 among 6633 persons who were tested at the KSUMC (positivity rate, 9.4%). MERS-CoV PCR was negative in all 99 patients tested. The majority of these 99 hospitalized patients were males (66%), had a mean age of 44 years (range, 19–87), and a quarter (25.3%) were health care workers. Patients with comorbid conditions accounted for 52.5% of patients including the 8.1% who were asymptomatic; diabetes mellitus being the most frequent (31.3%), followed by hypertension (22.2%). The most common presenting symptoms were fever (67.7%), cough (60.6%), dyspnea (43.4%), upper respiratory symptoms (27.3%), fatigue (26.3%), diarrhea (19.2%) and loss of smell (9.1%). The clinical conditions among these 99 patients included upper respiratory tract infection (47.5%), abnormal chest X-ray, lymphopenia, high inflammatory markers a fifth (21%) of patients had moderate pneumonia, while 7% had severe pneumonia with 22.2% requiring admission to the intensive care unit and 12.1% died. Late presentation with severe disease, an abnormal chest X-ray, lymphopenia, high inflammatory markers (C-reactive protein, ferritin, and procalcitonin), and end organ damage (high creatinine or high aspartate aminotransferase) were predictors for admission to critical care unit or died. Conclusion: We observed no MERS-CoV co-infection in this early cohort of hospitalized COVID-19 patients who were relatively young, more than half had comorbid conditions, presented with fever and/or cough, an abnormal chest X-ray, lymphopenia, and high inflammatory markers. Given MERS-CoV endemicity in the country, co-monitoring of MERS-CoV and SARS-CoV-2 coinfection is critical.

Temporal changes of haematological and radiological findings of the COVID-19 infection—a review of literature

“…This is a limitation as the number of COVID-19 cases and deaths in many other countries including the United States and several European countries have since exceeded that of China [ 7 ]. However, our review findings are similar to emerging evidence of haematological and radiological from other parts of the world [ 48 – 53 , 58 – 60 , 68 ].…”

“…Elevations in biomarkers such as CRP and LDH levels were also more significant in the later phase of the disease (DOO > 7 days) than the earlier phase (DOO ≤ 7 days). Similar elevation in CRP was also observed among patients in Saudi Arabia [ 48 ] and Iran [ 49 ] and was associated with mortality. CRP, an acute phase reactant, increases rapidly after the onset of inflammation, cell damage or organ injury in response to inflammatory cytokines [ 56 ].…”

“…Regardless of the number of days since onset of symptoms, lymphopenia can be seen in most hospitalised patients with COVID-19. Besides studies from China, studies from Saudi Arabia [ 48 ], Iran [ 49 ], India [ 50 ], South Korea [ 51 ], Singapore [ 52 ] and cruise ship (Diamond princess) [ 53 ] have also confirmed this finding However, the extent of lymphopenia is more prominent in the early phase (DOO ≤ 7 days) compared to those in the later phase (DOO > 7 days). It has been hypothesized that lymphopenia could be due to direct infection of the lymphocyte by the virus, destruction of lymphatic organs, lymphocyte apoptosis due to inflammation or inhibition of lymphocytes due to metabolic disorders like lactic acidosis [ 54 , 55 ].…”

Clinical characteristics of asymptomatic and symptomatic COVID-19 patients in the Eastern Province of Saudi Arabia

“…The Kingdom of Saudi Arabia had taken extensive preemptive strategies to curtail the spread of SARS-CoV-2 transmission [ 8 , 9 ]. There are limited published studies about COVID-19 in patients from the Gulf Cooperation Council (GCC) [ [10] , [11] , [12] ], and thus here we present the clinical presentation of the initial cases that were diagnosed in Saudi Arabia.…”

COVID-19 in a case previously infected with MERS-CoV: No cross immunity

“…2 Barry et al recently presented clinical characteristics of the first case series of 99 hospitalized COVID-19 patients admitted to one of three MERS-CoV reference centers in the KSA where no co-occurrence of MERS-CoV among SARS-CoV-2-infected persons were found. 6 There is overall paucity of published data during this pandemic of SARS-CoV-2 from MERS-CoV-endemic areas, especially the large-scale immunological studies that may help understand the potential cross-immunity which might explain the sharp reduction in MERS-CoV cases from KSA, for example during the COVID-19 pandemic, and guide future work on producing one vaccine for the two viruses.…”