Predictors of severity and mortality of COVID-19 at a tertiary care center in a Lower-middle income country

Abstract

Objective COVID-19 mortality and outcomes differ significantly across the globe. Limited data exists from low-middle income countries (LMICs) on risk-factors for COVID-19 severity and mortality. We describe the clinical spectrum and predictors of mortality and severity of illness in COVID-19 from a single center in Karachi, Pakistan. Methods Retrospective cohort study of adults admitted with COVID-19 between February-June 2020 were reviewed and logistic regression applied on admission related risk-factors for severity and mortality. Results A total of 445 patients [66.97% males, mean age 51.6 (18-91) years] were admitted with PCR confirmed COVID-19 during the study period. Asymptomatic and severe/critical disease occurred in 55 (12.36%) and 137 (30.79%) patients, respectively. The proportion of severe disease increased with time and most ( 268, 60.22%) had [?] 1 co-morbid. Disease severity was associated with age [?] 60 (OR:1.92), shortness of breath (OR:4.43) , CRP [?]150mg/L (OR:1.77), LDH [?] 500 I.U/L (OR:1.98), Neutrophil to Lymphocyte ratio (NLR) [?]5 (OR:2.80) and unit increase in serum creatinine (OR:1.32). All-cause mortality was 13%. Mortality was associated with septic shock (AOR= 13.2), age [?] 60 (AOR: 3.25), Ferritin [?] 1500ng/ml (AOR: 3.78) and NLR [?] 5 (AOR: 4.04). Conclusion We describe the experience with COVID-19 from a tertiary-care hospital in a LMIC. Our study found a comparatively low inpatient mortality, high proportion of diabetics, and neutrophil to lymphocyte ratio of greater than 5 as a predictor of both severity of illness and as poor prognostic marker in COVID-19.

Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan

“…ICU admission was needed for 59% (95/160). Approximately, 38.8% (66/170) required mechanical ventilation (MV) hence our patient population appears to be sicker compared to the only other unpublished data from the city[10].…”

“…ICU admission was needed for 59% (95/160). Approximately, 38.8% (66/170) required mechanical ventilation (MV) hence our patient population appears to be sicker compared to the only other unpublished data from the city [ 10 ]. We believe, being a private referral center they may have admitted milder spectrum patients for the purpose of isolation and monitoring.…”

Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan

“…Our patient population appears to be sicker compared to the only other unpublished data from the city. The reason for this difference could be admission of non-critical patients for monitoring and isolation since it was a private hospital [6] On the contrary, as mentioned before, our center is a philanthropic, free of cost referral centre for the underprivileged with limited bed capacity. Hence, admission was strictly reserved for critical patients.…”

Determinants that Associated with Traveling History of COVID-19 Patients in Ethiopia During Stay at Home State of Emergency

“…The study conducted by Goujon suggested that the observed gender differences point at the need to pay special attention to health care workers -regardless whether they are male or female [15]. Other studies consistent with this were [16][17][18][19].…”