Abstract
Objectives: Since December 2019, COVID-19 is engulfing the whole world day by day. It has a wide range of clinical manifestations which are evolving daily. We reviewed the factors associated with mortality among admitted COVID-19 patients by analysing their clinical profile and lab parameters.
Methods: Case records of 50 COVID-19 cases admitted to a medicine unit at AIIMS, New Delhi from April to mid-June were analysed retrospectively after applying inclusion and exclusion criteria. The course of disease was compared among survivors and non survivors.
Results: Among 50 subjects, 86% were below 60 years of age and 14% were above 60, mortality was higher in elderly age group and was statistically significant (p<0.05). Most patients were symptomatic; fever and dyspnoea being common presenting complain seen in 62% of patients followed by cough, myalgia, sore throat, diarrhoea and rash. Among patients who presented with all three symptoms at presentation (fever, cough & dyspnoea), 43% succumbed to disease. Looking at severity, 38% were mild, 42% were moderate and 20% were severe cases at admission. The mortality was highest in severe group (90%). Prior co morbidities were seen in 60% cases. Hypertension (24%) was the commonest followed by diabetes (18%) and CKD (6%). 66.7 % of patients with CKD died. Among non-survivors, 37.5% were anaemic and 72.7% had leucocytosis (p<0.05). 53.8% patients with raised urea and 36.3% patients with raised creatinine also died.
Conclusion: Older age, anaemia, leucocytosis and deranged renal function at the presentation are significantly associated with mortality among admitted COVID-19 patients.
Keywords: COVID-19 Disease, Risk Factors, Mortality.
References
- Koichi Yuki, Miho Fujiogi, Sophia Koutsogiannaki, COVID-19 pathophysiology: A review, Clin Immunol. 2020 Jun; 215: 108427
- https://www.worldometers.info/coronavirus/?utm_campaign=homeAdUOA?Si(Accessed on 21 August 2020)
- https://www.mohfw.gov.in/(Accessed on 21 August 2020)
- Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia, NEngl J Med. Published Online First: 29 January 2020. doi: https://doi.org/10.1056/NEJMoa2001316
- Wang, D., Yin, Y., Hu, C. et al. Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China. Crit Care24, 188 (2020). https://doi.org/10.1186/s13054-020-02895-6
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. Published Online First: 24 January 2020. doi: https://doi.org/10.1016/S0140-6736(20)30183-5
- https://www.mohfw.gov.in/pdf/ClinicalManagementProtocolforCOVID19.pdf( Accessed on 6 August 2020)
- https://www.who.int/vmnis/indicators/haemoglobin.pdf Accessed on 6 th August 2020)
- Hongdou Li, Shuang Wang, Fan Zhong, Wuyin Bao, Yipeng Li, Lei Liu, Hongyan Wang, Yungang He, Age-Dependent Risks of Incidence and Mortality of COVID-19 in Hubei Province and Other Parts of China, Front Med (Lausanne) 2020; 7: 190.
- Zhang, X. Wang, X. Jia, J. Li, K. Hu, G. Chen, J. Wei, Z. Gong, C. Zhou, H. Yu, M. Yu, H. Lei, F. Cheng, B. Zhang, Y. Xu, G. Wang, W. Dong Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China Clin Microbiol Infect. 2020 Jun; 26(6): 767–772. Published online 2020 Apr 15.doi: 10.1016/j.cmi.2020.04.01
- Du R-H, Liang L-R, Yang C-Q, et al. Predictors of Mortality for Patients with COVID-19 Pneumonia Caused by SARS-CoV-2: A Prospective Cohort Study. Eur Respir J 2020; in press (https://doi.org/10.1183/13993003.00524-2020).
- Huang Y, Tu M, Wang S, Chen S, Zhou W, Chen D, et al. Clinical characteristics of laboratory confirmed positive cases of SARS-CoV-2 infection in Wuhan, China: A retrospective single center analysis. Travel Med Infect Dis. 2020:101606.
- Wang L, Duan Y, Zhang W, Liang J, Xu J, Zhang Y, et al. Epidemiologic and Clinical Characteristics of 26 Cases of COVID-19 Arising from Patient-to-Patient Transmission in Liaocheng, China. Clin Epidemiol. 2020;12:387-91.
- Petek Eylul Taneri, Sergio Alejandro Gómez-Ochoa, Erand Llanaj, Peter Francis Raguindin, Lyda Z. Rojas, Beatrice Minder Wyssmann, Doris Kopp-Heim,Wolf E. Hautz , Michele F. Eisenga, Oscar H. Franco , Marija Glisic, Taulant Muka, Anemia and iron metabolism in COVID-19 : A systematic review and meta-analysis (doi:https://doi.org/10.1101/2020.06.04.20122267)
- Fei Zhou Ting Yu Ronghui Du Guohui Fan Ying Liu Zhibo Liu Jie Xiang Yeming Wang Bin Song Xiaoying Gu Lulu Guan Yuan Wei Hui Li Xudong Wu Jiuyang Xu Shengjin Tu Yi Zhang Hua Chen Bin Cao Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study Lancet 2020; 395: 1054–62
Corresponding Author
Dr Pankaj Jorwal
Associate Professor, Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi
DOI: https://dx.doi.org/10.18535/jmscr/v8i12.14
