Clinical Profile of First 1000 COVID-19 Cases Admitted at Tertiary Care Hospitals and the Correlates of their Mortality: An Indian Experience
Sandeep Budhiraja, Aakriti Soni, Vinitaa Jha, Dr Abhaya Indrayan, Arun Dewan, Omender Singh, Yogendra Pal Singh, Indermohan Chugh, Vijay Arora, Rajesh Pande, Abdul Ansari, Sujeet Jha
Objective: To describe the clinical profile and factors leading to increased mortality in coronavirus disease (COVID-19) patients admitted to a group of hospitals in India.
Design: A records-based study of the first 1000 patients with a positive result on real-time reverse transcriptase-polymerase-chain-reaction assay for SARS-CoV-2 admitted to our facilities. Various factors such as demographics, presenting symptoms, co-morbidities, ICU admission, oxygen requirement and ventilator therapy were studied. Results: Of the 1000 patients, 24 patients were excluded due to lack of sufficient data. Of the remaining 976 in the early phase of the epidemic, males were admitted twice as much as females (67.1% and 32.9%, respectively). Mortality in this initial phase was 10.6% and slightly higher for males and steeply higher for older patients. More than 8% reported no symptoms and the most common presenting symptoms were fever (78.3%), productive cough (37.2%), and dyspnea (30.64%). More than one-half (53.6%) had no co-morbidity. The major co-morbidities were hypertension (23.7%), diabetes without (15.4%), and with complications (9.6%). The co-morbidities were associated with higher ICU admissions, greater use of ventilators as well as higher mortality. A total of 29.9% were admitted to the ICU, with a mortality rate of 32.2%. Mortality was steeply higher in those requiring ventilator support (55.4%) versus those who never required ventilation (1.4%). The total duration of hospital stay was just a day longer in patients admitted to the ICU than those who remained in wards.
Conclusion: Male patients above the age of 60 and with co-morbidities faced the highest rates of mortality. They should be admitted to the hospital in early stage of the disease and given aggressive treatment to help reduce the morbidity and mortality associated with COVID-19.
Conflict of Interest: The authors report no conflict of interest. Ethical Approval: This study was approved by the ethics committee of MaxHealthcare (RS/MSSH/DDF/SKT-2/IEC/IM/20-16) Author contributions: Study conception and design: SB,AS. Acquisition, analysis, or interpretation of data: AI, VJ, AD, OS, YPS, IC, VA,RP,AA, AS. Drafting of the manuscript: AS. Critical revision of the manuscript for important intellectual content: SB, AI, VJ, SJ. Statistical analysis and interpretation: AI. Administrative, technical, or material support: VJ, AD, OS, YPS, IC, VA, RP, AA. Study supervision: SB, SJ, VJ. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. Competing Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare no support from any organization for the submitted work and no competing interests with regards to the submitted work.
Aggarwal, Shrivastava, Kumar, Ali, Clinical and epidemiological features of SARS-CoV-2 patients in SARI ward of a tertiary care centre in New Delhi, J Assoc Physic India
Alimohamadi, Taghdir, Sepandi, Estimate of the basic reproduction number for COVID-19: A systematic review and meta-analysis, J Prev Med Public Health, doi:10.3961/jpmph.20.076
Argenziano, Bruce, Slater, Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: Retrospective case series, BMJ, doi:10.1136/bmj.m1996
Bhandari, Rankawat, Bagarhatta, Clinico-radiological evaluation and correlation of CT chest images with progress of disease in COVID-19 patients, J Assoc Physic India
Docherty, Harrison, Green, Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: Prospective observational cohort study, BMJ, doi:10.1136/bmj.m1985
Fitzner, Qasmieh, Mounts, Revision of clinical case definitions: influenza-like illness and severe acute respiratory infection, Bull World Health Organ, doi:10.2471/BLT.17.194514
Gaur, Meena, Bairwa, Clinico-radiological presentation of COVID-19 patients at a tertiary care center at Bhilwara, Rajasthan, India, J Assoc Physic India
Grasselli, Zangrillo, Zanella, Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy, JAMA, doi:10.1001/jama.2020.5394
Grein, Ohmagari, Shin, Diaz, Compassionate use of remdesivir for patients with severe Covid-19, N Engl J Med, doi:10.1056/NEJMoa2007016
Guan, Ni, Hu, Liang, Ou, Clinical characteristics of coronavirus disease 2019 in China, N Engl J Med, doi:10.1056/NEJMoa2002032
Halpin, Faner, Sibila, Badia, Agusti, Do chronic respiratory diseases or their treatment affect the risk of SARS-CoV-2 infection?, Lancet Respir Med, doi:10.1016/S2213-2600(20)30167-3
Mohfw, Mohfw, None
Petrilli, Jones, Yang, Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: Prospective cohort study, BMJ, doi:10.1136/bmj.m1966
Pormohammad, Ghorbani, Khatami, Comparison of confirmed COVID -19 with SARS and MERS cases -Clinical characteristics, laboratory findings, radiographic signs and outcomes: A systematic review and meta-analysis, Rev Med Virol, doi:10.1002/rmv.2112
Ranney, Griffeth, Jha, Critical supply shortages -The need for ventilators and personal protective equipment during the Covid-19 pandemic, N Engl J Med, doi:10.1056/NEJMp2006141
Richardson, Hirsch, Narasimhan, Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area, JAMA, doi:10.1001/jama.2020.6775
Tirupathi, Bharathidasan, Palabindala, Salim, Tawfiq, Comprehensive review of mask utility and challenges during the COVID-19 pandemic, Infez Med
Xu, Han, Li, Sun, Effective treatment of severe COVID-19 patients with tocilizumab, Proc Natl Acad Sci U S A, doi:10.1073/pnas.2005615117
Zhang, Li, Shen, Chen, Zhigang, Rational use of tocilizumab in the treatment of novel coronavirus pneumonia, Clin Drug Investig, doi:10.1007/s40261-020-00950-2