Clinical Variants, Characteristics, and Outcomes Among COVID-19 Patients: A Case Series Analysis at a Tertiary Care Hospital in Karachi, Pakistan

Abstract

IntroductionCoronavirus disease 2019 has become a global threat to public health. The current study investigates alterations in the biological estimates concerning the severity, recovery, mortality, and assessment of treatment-based outcomes. MethodsA case series of 165 COVID-19 patients admitted to OMI Institute (a tertiary care hospital) was conducted between May and August 2020. The data regarding demographic characteristics, comorbid conditions, radiographic abnormalities, biological estimations, symptoms, treatment, disease progression, complications, and outcomes were recorded using a structured questionnaire. Laboratory estimations included complete blood count (CBC), renal and electrolyte profile, liver function tests (LFTs), hematological indices, and inflammatory markers. Chest X-ray, electrocardiogram (ECG), and a high-resolution computed tomography (HRCT) scan were also performed, and data were extracted from the medical records. Analysis was done using the Statistical Package for the Social Sciences (SPSS) version 22.0. ResultsOut of the 165 COVID-19 patients, 79.4% recovered and were successfully discharged, while 20.6% of inpatient died. The patients' mean age was 56.03 ± 15.96 years, with a male majority (55.1%). The most common comorbid conditions were diabetes and hypertension; fever and dry cough were among the most frequently reported symptoms. The chest imaging findings among the severe/critical COVID-19 patients showed extensive bilateral patchy opacities. The median laboratory investigations, including neutrophil-tolymphocyte ratio (NLR) (14.83), C-reactive protein (CRP) (7.4 mg/dl), lactate dehydrogenase (LDH) (786 IU/L), ferritin (1401.15 mcg/ml), and mean oxygen saturation (88.25%), were significantly altered among cases with increased disease severity and those who expired (p<0.05). The proportion of acute respiratory distress syndrome (ARDS) and sepsis development was significantly high among severe/critical COVID-19 patients (p<0.05). Treatment with tocilizumab, remdesivir, doxycycline, ivermectin, enoxaparin sodium, and steroids was deemed to be potentially effective treatment options in terms of reducing COVID-19 severity and chances of recovery. Furthermore, age (OR 1.05; p=0.047), presence of comorbidity (OR 8.471; p=0.004), high NLR, LDH (final outcome) (OR 1.361 and 1.018; p<0.05), and CRP levels (midpoint) (OR 1.631; p=0.05) were identified as the strong predictors of death among COVID-19 patients. ConclusionThe study identified several alterations in the clinical profile of the COVID-19 patients concerning severity during the hospital stay, affecting prognosis. Clinically, tocilizumab, remdesivir, doxycycline, ivermectin, enoxaparin sodium, and steroids were identified as potential therapeutic options for COVID-19 due to their ability to alter disease-associated severity and recovery rate.

Real-Life Use of Tocilizumab in the Treatment of Severe COVID-19 Pneumonia

“…NLR levels were significantly higher in both deceased and not improved groups. High NLR level at the administration of TCZ is, therefore, a significant risk factor for mortality in our population, which is consistent with a meta-analysis conducted by Li et al among 34 studies with COVID-19 patients and was also reported by Ahsan et al that high NLR level was a strong predictor of death among COVID-19 patients [ 32 , 33 ].…”

Psychological and Clinical Predictors of COVID-19 Severity and Outcomes

“…Furthermore, among the laboratory parameters, oxygen saturation, ferritin, D-dimers, creatinine, PT, and INR were significantly altered, and with that, these estimations greatly varied among recovered and deceased patients (p<0.05). These findings are also supported by similar local studies [22,23].…”

“…Among the significant predictors of COVID-19 severity and outcomes were age, hypertension, fatigue, abnormal respiratory rate, oxygen saturation, blood glucose level, ferritin, and HADS. Consistent with this, a local case series from Pakistan identified age, presence of comorbidity, high neutrophil-to-lymphocyte ratio (NLR), LDH, and CRP levels as strong predictors of mortality among COVID-19 patients [22], which is also supported by other international studies [24]. But to the best of our knowledge, none of the studies focused on the psychological determinants as the potential predictors of mortality among COVID-19 patients, specifically in Pakistan.…”

RETRACTED: Microbiome-Based Hypothesis on Ivermectin’s Mechanism in COVID-19: Ivermectin Feeds Bifidobacteria to Boost Immunity

“…Over 40 peer-reviewed studies ( Table 1 ) have demonstrated studies on the effectiveness of IVM in SARS-CoV-2 infection ( Alam et al, 2020 ; Khan et al, 2020 ; Kishoria et al, 2020 ; Reaz et al, 2020 ; Abd-Elsalam et al, 2021 ; Ahmed et al, 2021 ; Ahsan et al, 2021 ; Aref et al, 2021 ; Behera et al, 2021 ; Cadegiani et al, 2021 ; Chaccour et al, 2021 ; Chahla et al, 2021 ; Chowdhury et al, 2021 ; Elalfy et al, 2021 ; Faisal et al, 2021 ; Ferreira et al, 2021 ; Hellwig and Maia, 2021 ; Krolewiecki et al, 2021 ; Lima-Morales et al, 2021 ; López-Medina et al, 2021 ; Mohan et al, 2021 ; Morgenstern et al, 2021 ; Mukarram, 2021 ; Okumuş et al, 2021 ; Podder et al, 2021 ; Rajter et al, 2021 ; Ravikirti et al, 2021 ; Rezk et al, 2021 ; Seet et al, 2021 ; Shahbaznejad et al, 2021 ; Shoumann et al, 2021 ; Abbas et al, 2022 ; Ascencio-Montiel et al, 2022 ; Babalola et al, 2022 ; Beltran Gonzalez et al, 2022 ; Buonfrate et al, 2022 ; Hazan et al, 2022a ; Kerr et al, 2022 ; Lim et al, 2022 ; Mayer et al, 2022 ; Mustafa et al, 2022 ; Ozer et al, 2022 ; Reis et al, 2022 ; Shimizu et al, 2022 ; Zubair et al, 2022 ), with over 80% of studies showing positive outcomes with IVM treatment. Overall, IVM has shown 60–85% improvement in outcomes, including mortality, ventilation, recovery, clearance, and hospital/ICU admissions.…”