Clinical characteristics and outcomes of COVID-19: Experience at a major tertiary care center in Pakistan

Abstract

Introduction: Limited data exist on clinical characteristics and outcomes of hospitalized COVID-19 patients in low-middle income countries. We aimed to describe the clinical spectrum and outcomes of hospitalized COVID-19 patients at a tertiary-care center in Karachi, Pakistan.
 Methodology: We conducted an observational study of adult COVID-19 patients hospitalized between February-June 2020. Patients with a discharge diagnosis of COVID-19 and PCR positivity were included. We created logistic regression models to understand association of clinical characteristics with illness severity and in-hospital mortality.
 Results: The study population comprised 445 patients [67% males, median age 53 (IQR 40-64) years]. Majority of patients (N = 268; 60%) had ≥ 1 co-morbid [37.5% hypertension, 36.4% diabetes]. In-hospital mortality was 13%. Age ≥ 60 (aOR] =1.92; 95 %CI = 1.23-3.03), shortness of breath (aOR=4.43; 95% CI=2.73-7.22), CRP ≥150mg/L (aOR:1.77; 95% CI=1.09-2.85), LDH ≥ 500 I.U/L (aOR:1.98; 95% CI=1.25-3.16), Neutrophil-to-Lymphocyte ratio (NLR) ≥5 (aOR:2.80; 95%CI = 1.77-4.42) and increase in serum creatinine (aOR:1.32; 95%CI=1.07-1.61) were independently associated with disease severity. Septic shock (aOR: 13.27; 95% CI=3.78-46.65), age ≥ 60 (aOR: 3.26; 95% CI=1.07-9.89), Ferritin ≥ 1500ng/ml (aOR: 3.78; 95% CI=1.21-11.8), NLR ≥ 5 (aOR: 4.04; 95% CI=1.14-14.35) and acute kidney injury (aOR: 5.52; 95% CI=1.78-17.06) were independent predictors of in-hospital mortality.
 Conclusions: We found multiple predictors to be independently associated with in-hospital mortality, except diabetes and gender. Compared to reports from other countries, the in-hospital mortality among COVID-19 patients was lower, despite a high burden of co-morbidities. Further research is required to explore reasons behind this dichotomy.

Upregulated type I interferon responses in asymptomatic COVID-19 infection are associated with improved clinical outcome

“…Over the same period studied, the Sindh Health Department COVID-19 report indicated that 76% of confirmed cases were below 50 years of age 26 with a similar trend was observed in national data. Nasir et al showed that there were no specific factors associated with hospital related morbidity and mortality of COVID-19 in Pakistan, except for an older age group 27 . These study samples were from between March and October 2020.…”

Clinical profile and short-term outcomes of RT-PCR- positive patients with COVID-19: a cross-sectional study in a tertiary care hospital in Dhaka, Bangladesh

“… 32 33 Similar to our finding, a significant association between lower SpO2 level or severe illness with older age and the presence of any comorbidity was reported in Pakistan. 22 Besides, the severe illness was significantly associated with radiological findings of pneumonia, 34 higher creatinine, 35 C reactive protein 18 and neutrophil:lymphocyte ratio. 36 37 A higher proportion of patients with low SpO 2 levels frequently received antibiotics, anticoagulants and glucocorticoid therapy.…”

“… 36 37 A higher proportion of patients with low SpO 2 levels frequently received antibiotics, anticoagulants and glucocorticoid therapy. 22 38 Other studies from Bangladesh also reported that antibiotics are the most commonly used medication during the treatment of COVID-19. 24 39 …”

“…15 However, other studies conducted in India and Pakistan found an even higher case-fatality ratio (around 10%) among patients admitted in tertiary care settings. 22 40 We followed up with 399 patients to investigate their postdischarge complications, and about 41.10% reported at least one complication. Respiratory complications were reported most frequently as persistent symptoms after discharge.…”

“…Similar studies conducted in the tertiary care centres in Bangladesh, India and Pakistan also reported higher levels of pre-existing comorbidity among patients with COVID-19. [22][23][24] Saha et al 25 has found that comorbidity such as cardiovascular disease, hypertension and diabetes are significant risk factors for the poor prognosis of COVID-19 in Bangladesh. 25 Several meta-analyses also indicated a higher disease burden of COVID-19 among male smokers and patients with comorbid conditions such as cardiovascular disease, hypertension and diabetes.…”