Epidemiological, Clinical, and Laboratory Predictors of In-Hospital Mortality Among COVID-19 Patients Admitted in a Tertiary COVID Dedicated Hospital, Northern India: A Retrospective Observational Study

Ahmad, Shamshad; Kumar, Pragya; Shekhar, Shashank; Saha, Rubina; Ranjan, Alok; Pandey, Sanjay Kumar

doi:10.1177/21501327211041486

Cited by 14 publications

(17 citation statements)

References 31 publications

(39 reference statements)

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“…According to large observational studies, the mortality of hospitalized COVID-19 patients declined from 30% in early-2020 to 15% in mid-2020 [ 79 ]. Observational studies in India, where many CAM studies were conducted, reported the mortality of hospitalized COVID-19 patients of 10% in mid-2020 [ 80 ]. Based on our meta-analysis, patients who developed CAM may present worse outcomes than the COVID-19 patients without CAM, although the causal relationship remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis

Watanabe

Mitaka

et al. 2022

Mycopathologia

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The recent increase of COVID-19-associated mucormycosis (CAM) has been commanding global attention. However, basic epidemiologic characteristics have not firmly been established. In this systematic review and meta-analysis, we sought to determine the clinical manifestations, potential risk factors, and outcomes of CAM. Observational studies reporting CAM were searched with PubMed and EMBASE databases in January 2022. We collected data on comorbidities and treatment for COVID-19, and performed a one-group meta-analysis on the frequency of orbital exenteration procedure and mortality of CAM using a random-effect model. Fifty-one observational studies, including a total of 2,312 patients with proven CAM, were identified. Among the 51 studies, 37 were conducted in India, 8 in Egypt, and 6 in other countries. The most common comorbidity was diabetes mellitus (82%). While 57% required oxygenation, 77% received systemic corticosteroids. Among CAM, 97% were rhino-orbital-cerebral (ROCM), and 2.7% were pulmonary mucormycosis. Usual presentations were headache (54%), periorbital swelling/pain (53%), facial swelling/pain (43%), ophthalmoplegia (42%), proptosis (41%), and nasal discharge/congestion (36%). Regarding the outcomes, orbital exenteration was performed in 17% (95% CI: 12–21%, I 2 = 83%) of the COVID-19-associated ROCM patients. The mortality of CAM was 29% (95% CI; 22–36%, I 2 = 92%). In conclusion, this systematic review and meta-analysis indicated that the most prevalent type of CAM was ROCM, and most CAM patients had diabetes mellitus and received systemic glucocorticoids. Clinicians in the endemic areas should have a high index of suspicion for this invasive fungal complication of COVID-19 when a diabetic patient who received high-dose systemic glucocorticoids developed rhino-orbital symptoms.

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Section: Discussionmentioning

confidence: 99%

Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis

Watanabe

Mitaka

et al. 2022

Mycopathologia

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“…Risk factors for mortality in COVID-19 reported in various studies included advanced age [ 2 – 13 ], male gender [ 6 , 7 , 9 , 11 , 13 ] and comorbidities [ 3 , 5 , 6 , 9 – 16 ] like diabetes mellitus, obesity, systemic hypertension, renal diseases, coronary artery disease [ 12 ] and malignancy. Apart from manifestations such as fever [ 8 ], cough [ 8 ], haemoptysis [ 2 ], dyspnoea [ 2 , 6 , 8 ], fatigue [ 8 ], loss of consciousness [ 2 , 6 ], laboratory parameters such as elevation of Neutrophil-to-Lymphocyte Ratio (NLR) [ 2 , 15 ], and increased levels of creatinine [ 3 ], lactate dehydrogenase (LDH) [ 2 – 4 , 10 , 12 ], direct bilirubin [ 2 ] and alanine aminotransferase [ 3 ], which provide early clues to the severity of disease, an increased plasma level of biomarkers like D-dimer [ 3 – 5 , 12 ], C-Reactive Protein (CRP) [ 6 , 7 ], serum ferritin [ 3 ], Interleukin-6 (IL-6) [ 3 ], and procalcitonin (PCT) fortifies these findings[ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of mortality among hospitalized COVID-19 patients and risk score formulation for prioritizing tertiary care—An experience from South India

Narendran

Senthil²,

Prabakar³

et al. 2022

PLoS ONE

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Background We retrospectively data-mined the case records of Reverse Transcription Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients hospitalized to a tertiary care centre to derive mortality predictors and formulate a risk score, for prioritizing admission. Methods and findings Data on clinical manifestations, comorbidities, vital signs, and basic lab investigations collected as part of routine medical management at admission to a COVID-19 tertiary care centre in Chengalpattu, South India between May and November 2020 were retrospectively analysed to ascertain predictors of mortality in the univariate analysis using their relative difference in distribution among ‘survivors’ and ‘non-survivors’. The regression coefficients of those factors remaining significant in the multivariable logistic regression were utilised for risk score formulation and validated in 1000 bootstrap datasets. Among 746 COVID-19 patients hospitalised [487 “survivors” and 259 “non-survivors” (deaths)], there was a slight male predilection [62.5%, (466/746)], with a higher mortality rate observed among 40–70 years age group [59.1%, (441/746)] and highest among diabetic patients with elevated urea levels [65.4% (68/104)]. The adjusted odds ratios of factors [OR (95% CI)] significant in the multivariable logistic regression were SaO2<95%; 2.96 (1.71–5.18), Urea ≥50 mg/dl: 4.51 (2.59–7.97), Neutrophil-lymphocytic ratio (NLR) >3; 3.01 (1.61–5.83), Age ≥50 years;2.52 (1.45–4.43), Pulse Rate ≥100/min: 2.02 (1.19–3.47) and coexisting Diabetes Mellitus; 1.73 (1.02–2.95) with hypertension and gender not retaining their significance. The individual risk scores for SaO2<95–11, Urea ≥50 mg/dl-15, NLR >3–11, Age ≥50 years-9, Pulse Rate ≥100/min-7 and coexisting diabetes mellitus-6, acronymed collectively as ‘OUR-ARDs score’ showed that the sum of scores ≥ 25 predicted mortality with a sensitivity-90%, specificity-64% and AUC of 0.85. Conclusions The ‘OUR ARDs’ risk score, derived from easily assessable factors predicting mortality, offered a tangible solution for prioritizing admission to COVID-19 tertiary care centre, that enhanced patient care but without unduly straining the health system.

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“…Similar results were observed in a study in India and in a study in China also. 22,23 The association of CKD might be due to the fact that ACE2, the cell entry receptor of SAR-CoV-2 is expressed almost 100 times higher in the kidneys compared to lungs. 24…”

Section: Discussionmentioning

confidence: 99%

Predictors of mortality among COVID-19 patients admitted in a dedicated COVID hospital during the pandemic in Himachal Pradesh, India

Thakur

2022

Int J Community Med Public Health

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Background: The outcome of COVID-19 disease is variable. Mostly patients have mild to moderate disease and get recovered; some patients have severe disease leading to mortality. Hence it is essential to find out the factors affecting the outcome in the COVID-19 patients. The aim of this study was to identify predictors of mortality among hospitalized patients of COVID-19 and to estimate their prevalence among these patients.Methods: This was an observational study, longitudinal in design, carried out among 790 COVID-19 patients hospitalized in a tertiary care dedicated COVID hospital in Himachal, during the second wave of COVID.Results: Overall 26.2% of the hospitalized patients were having one or more co morbidities. DM (17.6%) and delayed hospitalization (42.7%) were highly prevalent risk factors among hospitalized patients with high mortality 39.6% and 49% respectively. Overall mortality rate among study participants was 29.7%. Patients having malignancy and other immuno-compromising diseases had highest mortality rate 68.4%. Median time gap between onset of symptoms and hospitalization was 9 days among those who died and 5 days among those who recovered. On multivariate logistic regression analysis higher age (>60 years) AOR 5.392 (3.435-8.463), delayed hospital admission AOR 8.204 (5.522-12.188), diabetes mellitus AOR 1.888 (CI-1.199-2.972), malignancy and other immune compromising diseases AOR 9.108 (2.934-28.270) and chronic kidney disease AOR 7.524 (CI=2.289-27.735) were the significant predictors of mortality.Conclusions: We observed the higher COVID-19 mortality among the patients having higher age, DM, CKD, immunocompromising diseases and delay in hospitalization. DM and delayed hospitalization were two most prevalent risk factors present among these patients.

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Epidemiological, Clinical, and Laboratory Predictors of In-Hospital Mortality Among COVID-19 Patients Admitted in a Tertiary COVID Dedicated Hospital, Northern India: A Retrospective Observational Study

Cited by 14 publications

References 31 publications

Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis

Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis

Predictors of mortality among hospitalized COVID-19 patients and risk score formulation for prioritizing tertiary care—An experience from South India

Predictors of mortality among COVID-19 patients admitted in a dedicated COVID hospital during the pandemic in Himachal Pradesh, India

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