Determinants of Outcome Among Critically Ill Police Personnel With COVID-19: A Retrospective Observational Study From Andhra Pradesh, India
Limalemla Jamir, Mukesh Tripathi, Sumita Shankar, Rakesh Kakkar, Ravishankar Ayyanar, Rajeev Aravindakshan
Cureus, doi:10.7759/cureus.20394
Background and Aims: Police personnel have been key frontline workers throughout the coronavirus disease 2019 pandemic. This study was conducted to assess the correlates and outcomes of critically ill police personnel. Methods: This retrospective observational study analyzed key parameters of hospitalized police personnel who were critically ill with COVID-19 in Andhra Pradesh, India, between June and October 2020. Survival was analyzed for correlation with body mass index, ABO/Rh blood group, co-morbidities, treatment (oxygen therapy, prone positioning, mechanical ventilation, remdesivir, Ivermectin, oral and nasal topical povidoneiodine). We also performed Cox proportional hazard analysis with relevant function plots. Results: The majority of the 266 patients were male (n = 259; 97.4%) and obese (75.2%). The overall mortality of patients was 38% (n = 101). COVID-19 mortality increased significantly with age (p = 0.019) and BMI (p = 0.030) in the bivariate analysis. There was no significant difference between blood group (p = 0.297), comorbidity (p = 0.582) and COVID-19 outcome. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of the risk factors for COVID-19 mortality were males (HR 4.89, 95% CI: 1.020-23.430) and ventilator therapy (HR 7.5, 95% CI: 4.527-12.296). The protective factors were symptom onset to reverse transcription polymerase chain reaction (RT-PCR) report interval (HR 0.36, 95% CI: 0.158-0.814), prone positioning (HR 0.43, 95% CI: 0.197-0.915), and use of povidone iodine (HR 0.43; 95% CI: 0.273-0.692). Conclusion: COVID-19 mortality among critically ill hospitalized police personnel was reduced by time to diagnostic test result, prone positioning, and povidone-iodine use and increased with male gender and mechanical ventilation.
Additional Information Disclosures Human subjects: Consent was obtained or waived by all participants in this study. All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh issued approval IEC-AIIMS/Mangalagiri/2020-21/40. The committee after critical review and discussion of the documents approved the Research Study in All India institute Of Medical Sciences, Mangalagiri vide IEC-AIIMS/Mangalagiri/2020-21/40 dated 12.06.2021. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
References
Mallik, Mukhopadhyay, Kumar, Hypertension, prehypertension and normotension among police personnel in a district of West Bengal, India, J Assoc Physicians India
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"DOI": "10.1186/s12916-021-01923-8",
"article-title": "Who should be prioritized for COVID-19 vaccination in China? A descriptive study",
"author": "Yang J",
"doi-asserted-by": "publisher",
"journal-title": "BMC Med",
"key": "ref1",
"unstructured": "Yang J, Zheng W, Shi H, et al.. Who should be prioritized for COVID-19 vaccination in China? A descriptive study. BMC Med. 2021, 19:45. 10.1186/s12916-021-01923-8",
"volume": "19",
"year": "2021"
},
{
"DOI": "10.1080/07420528.2020.1831524",
"article-title": "COVID-19 pandemic lockdown-induced altered sleep/wake circadian rhythm, health complaints and stress among traffic police personnel in India",
"author": "Dey A",
"doi-asserted-by": "publisher",
"journal-title": "Chronobiol Int",
"key": "ref2",
"unstructured": "Dey A, Majumdar P, Saha A, Sahu S. COVID-19 pandemic lockdown-induced altered sleep/wake circadian rhythm, health complaints and stress among traffic police personnel in India. Chronobiol Int. 2021, 38:140-8. 10.1080/07420528.2020.1831524",
"volume": "38",
"year": "2021"
},
{
"DOI": "10.1093/pubmed/fdaa079",
"article-title": "COVID-19 in Peru: the need to pay attention to the high number of police deaths due to the pandemic",
"author": "Hernández-Vásquez A",
"doi-asserted-by": "publisher",
"journal-title": "J Public Health (Oxf)",
"key": "ref3",
"unstructured": "Hernández-Vásquez A, Azañedo D. COVID-19 in Peru: the need to pay attention to the high number of police deaths due to the pandemic. J Public Health (Oxf). 2020, 42:640-1. 10.1093/pubmed/fdaa079",
"volume": "42",
"year": "2020"
},
{
"DOI": "10.1097/TA.0000000000003085",
"article-title": "Multisystem outcomes and predictors of mortality in critically ill patients with COVID-19: demographics and disease acuity matter more than comorbidities or treatment modalities",
"author": "Alser O",
"doi-asserted-by": "publisher",
"journal-title": "J Trauma Acute Care Surg",
"key": "ref4",
"unstructured": "Alser O, Mokhtari A, Naar L, et al.. Multisystem outcomes and predictors of mortality in critically ill patients with COVID-19: demographics and disease acuity matter more than comorbidities or treatment modalities. J Trauma Acute Care Surg. 2021, 90:880-90. 10.1097/TA.0000000000003085",
"volume": "90",
"year": "2021"
},
{
"DOI": "10.1371/journal.pone.0252760",
"article-title": "Variation in outcome of invasive mechanical ventilation between different countries for patients with severe COVID-19: a systematic review and meta-analysis",
"author": "Elsayed HH",
"doi-asserted-by": "publisher",
"journal-title": "PLoS One",
"key": "ref5",
"unstructured": "Elsayed HH, Hassaballa AS, Ahmed TA, Gumaa M, Sharkawy HY, Moharram AA. Variation in outcome of invasive mechanical ventilation between different countries for patients with severe COVID-19: a systematic review and meta-analysis. PLoS One. 2021, 16:e0252760. 10.1371/journal.pone.0252760",
"volume": "16",
"year": "2021"
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"key": "ref6",
"unstructured": "Clinical management protocol. COVID-19. (2020). Accessed: August 10, 2021: https://www.mohfw.gov.in/pdf/ClinicalManagementProtocolforCOVID19dated27062020.pdf."
},
{
"DOI": "10.1530/EJE-21-0068",
"article-title": "Sex disparities in COVID-19 outcomes of inpatients with diabetes: insights from the CORONADO study",
"author": "Tramunt B",
"doi-asserted-by": "publisher",
"journal-title": "Eur J Endocrinol",
"key": "ref7",
"unstructured": "Tramunt B, Smati S, Coudol S, et al.. Sex disparities in COVID-19 outcomes of inpatients with diabetes: insights from the CORONADO study. Eur J Endocrinol. 2021, 185:299-311. 10.1530/EJE-21-0068",
"volume": "185",
"year": "2021"
},
{
"DOI": "10.1016/j.acvd.2021.04.002",
"article-title": "Characteristics and impact of cardiovascular comorbidities on coronavirus disease 2019 in women: a multicentre cohort study",
"author": "Weizman O",
"doi-asserted-by": "publisher",
"journal-title": "Arch Cardiovasc Dis",
"key": "ref8",
"unstructured": "Weizman O, Mika D, Cellier J, et al.. Characteristics and impact of cardiovascular comorbidities on coronavirus disease 2019 in women: a multicentre cohort study. Arch Cardiovasc Dis. 2021, 114:394-406. 10.1016/j.acvd.2021.04.002",
"volume": "114",
"year": "2021"
},
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"DOI": "10.1007/s00277-020-04169-1",
"article-title": "Blood type and outcomes in patients with COVID-19",
"author": "Latz CA",
"doi-asserted-by": "publisher",
"journal-title": "Ann Hematol",
"key": "ref9",
"unstructured": "Latz CA, DeCarlo C, Boitano L, et al.. Blood type and outcomes in patients with COVID-19. Ann Hematol. 2020, 99:2113-8. 10.1007/s00277-020-04169-1",
"volume": "99",
"year": "2020"
},
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"DOI": "10.2450/2021.0049-21",
"article-title": "ABO blood group and COVID-19: an updated systematic literature review and meta-analysis",
"author": "Franchini M",
"doi-asserted-by": "publisher",
"journal-title": "Blood Transfus",
"key": "ref10",
"unstructured": "Franchini M, Cruciani M, Mengoli C, et al.. ABO blood group and COVID-19: an updated systematic literature review and meta-analysis. Blood Transfus. 2021, 19:317-26. 10.2450/2021.0049-21",
"volume": "19",
"year": "2021"
},
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"DOI": "10.15585/mmwr.mm7010e4",
"article-title": "Body mass index and risk for COVID-19-related hospitalization, intensive care unit admission, invasive mechanical ventilation, and death - United States, March-December 2020",
"author": "Kompaniyets L",
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"volume": "70",
"year": "2021"
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"DOI": "10.1016/j.metabol.2020.154373",
"article-title": "Association of body mass index (BMI) with critical COVID-19 and in-hospital mortality: a dose-response meta-analysis",
"author": "Du Y",
"doi-asserted-by": "publisher",
"journal-title": "Metabolism",
"key": "ref12",
"unstructured": "Du Y, Lv Y, Zha W, Zhou N, Hong X. Association of body mass index (BMI) with critical COVID-19 and in-hospital mortality: a dose-response meta-analysis. Metabolism. 2021, 117:154373. 10.1016/j.metabol.2020.154373",
"volume": "117",
"year": "2021"
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"DOI": "10.1016/j.orcp.2021.02.008",
"article-title": "Does there exist an obesity paradox in COVID-19? Insights of the international HOPE-COVID-19-registry",
"author": "Abumayyaleh M",
"doi-asserted-by": "publisher",
"journal-title": "Obes Res Clin Pract",
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"volume": "15",
"year": "2021"
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"DOI": "10.4103/ijoem.IJOEM_105_17",
"article-title": "Are police personnel in Puducherry healthy? Findings from \"Partners in Prevention\" programme in Puducherry, India",
"author": "Ravikumar TS",
"doi-asserted-by": "publisher",
"journal-title": "Indian J Occup Environ Med",
"key": "ref14",
"unstructured": "Ravikumar TS, Kanagarethinam R, Nair D, Kar SS. Are police personnel in Puducherry healthy? Findings from \"Partners in Prevention\" programme in Puducherry, India. Indian J Occup Environ Med. 2017, 21:84-8. 10.4103/ijoem.IJOEM_105_17",
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"key": "ref15",
"unstructured": "Mallik D, Mukhopadhyay DK, Kumar P, et al.. Hypertension, prehypertension and normotension among police personnel in a district of West Bengal, India. J Assoc Physicians India. 2014, 62:12-6.",
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"year": "2014"
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"DOI": "10.1159/000510953",
"article-title": "Does asthma increase the mortality of patients with COVID-19?: A systematic review and meta-analysis",
"author": "Wang Y",
"doi-asserted-by": "publisher",
"journal-title": "Int Arch Allergy Immunol",
"key": "ref16",
"unstructured": "Wang Y, Chen J, Chen W, et al.. Does asthma increase the mortality of patients with COVID-19?: A systematic review and meta-analysis. Int Arch Allergy Immunol. 2021, 182:76-82. 10.1159/000510953",
"volume": "182",
"year": "2021"
},
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"DOI": "10.1177/1479973120986806",
"article-title": "Contribution of pulmonary diseases to COVID-19 mortality in a diverse urban community of New York",
"author": "Girardin JL",
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"journal-title": "Chron Respir Dis",
"key": "ref17",
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"volume": "18",
"year": "2021"
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"DOI": "10.1016/S2213-2600(21)00013-8",
"article-title": "Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK",
"author": "Bloom CI",
"doi-asserted-by": "publisher",
"journal-title": "Lancet Respir Med",
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"unstructured": "Bloom CI, Drake TM, Docherty AB, et al.. Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK. Lancet Respir Med. 2021, 9:699-711. 10.1016/S2213-2600(21)00013-8",
"volume": "9",
"year": "2021"
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"DOI": "10.1513/AnnalsATS.202007-803OC",
"article-title": "The impact of high-flow nasal cannula use on patient mortality and the availability of mechanical ventilators in COVID-19",
"author": "Gershengorn HB",
"doi-asserted-by": "publisher",
"journal-title": "Ann Am Thorac Soc",
"key": "ref19",
"unstructured": "Gershengorn HB, Hu Y, Chen JT, Hsieh SJ, Dong J, Gong MN, Chan CW. The impact of high-flow nasal cannula use on patient mortality and the availability of mechanical ventilators in COVID-19. Ann Am Thorac Soc. 2021, 18:623-31. 10.1513/AnnalsATS.202007-803OC",
"volume": "18",
"year": "2021"
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"DOI": "10.1186/s12890-021-01401-0",
"article-title": "Prone during pandemic: development and implementation of a quality-based protocol for proning severe COVID-19 hypoxic lung failure patients in situationally or historically low resource hospitals",
"author": "Astua AJ",
"doi-asserted-by": "publisher",
"journal-title": "BMC Pulm Med",
"key": "ref20",
"unstructured": "Astua AJ, Michaels EK, Michaels AJ. Prone during pandemic: development and implementation of a quality-based protocol for proning severe COVID-19 hypoxic lung failure patients in situationally or historically low resource hospitals. BMC Pulm Med. 2021, 21:25. 10.1186/s12890-021-01401-0",
"volume": "21",
"year": "2021"
},
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"DOI": "10.1186/s13054-021-03552-2",
"article-title": "Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients",
"author": "Langer T",
"doi-asserted-by": "publisher",
"journal-title": "Crit Care",
"key": "ref21",
"unstructured": "Langer T, Brioni M, Guzzardella A, et al.. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients. Crit Care. 2021, 25:128. 10.1186/s13054-021-03552-2",
"volume": "25",
"year": "2021"
},
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"DOI": "10.5005/jp-journals-10071-23816",
"article-title": "Timing of invasive mechanical ventilation and mortality among patients with severe COVID-19-associated acute respiratory distress syndrome",
"author": "Zirpe KG",
"doi-asserted-by": "publisher",
"journal-title": "Indian J Crit Care Med",
"key": "ref22",
"unstructured": "Zirpe KG, Tiwari AM, Gurav SK, et al.. Timing of invasive mechanical ventilation and mortality among patients with severe COVID-19-associated acute respiratory distress syndrome. Indian J Crit Care Med. 2021, 25:493-8. 10.5005/jp-journals-10071-23816",
"volume": "25",
"year": "2021"
},
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"DOI": "10.1016/j.aucc.2020.10.009",
"article-title": "Mechanical ventilation and mortality among 223 critically ill patients with coronavirus disease 2019: a multicentric study in Germany",
"author": "Roedl K",
"doi-asserted-by": "publisher",
"journal-title": "Aust Crit Care",
"key": "ref23",
"unstructured": "Roedl K, Jarczak D, Thasler L, et al.. Mechanical ventilation and mortality among 223 critically ill patients with coronavirus disease 2019: a multicentric study in Germany. Aust Crit Care. 2021, 34:167-75. 10.1016/j.aucc.2020.10.009",
"volume": "34",
"year": "2021"
},
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"DOI": "10.5935/0103-507X.20200082",
"article-title": "Clinical characteristics and predictors of mechanical ventilation in patients with COVID-19 hospitalized in Southern Brazil",
"author": "Bastos GA",
"doi-asserted-by": "publisher",
"journal-title": "Rev Bras Ter Intensiva",
"key": "ref24",
"unstructured": "Bastos GA, Azambuja AZ, Polanczyk CA, et al.. Clinical characteristics and predictors of mechanical ventilation in patients with COVID-19 hospitalized in Southern Brazil. Rev Bras Ter Intensiva. 2020, 32:487-92. 10.5935/0103-507X.20200082",
"volume": "32",
"year": "2020"
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"DOI": "10.1056/NEJMoa2023184",
"article-title": "Repurposed antiviral drugs for Covid-19 - interim WHO Solidarity Trial results",
"author": "Pan H",
"doi-asserted-by": "publisher",
"journal-title": "N Engl J Med",
"key": "ref25",
"unstructured": "Pan H, Peto R, Henao-Restrepo AM, et al.. Repurposed antiviral drugs for Covid-19 - interim WHO Solidarity Trial results. N Engl J Med. 2021, 384:497-511. 10.1056/NEJMoa2023184",
"volume": "384",
"year": "2021"
},
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"DOI": "10.1097/MJT.0000000000001402",
"article-title": "Ivermectin for prevention and treatment of COVID-19 infection: a systematic review, meta-analysis, and trial sequential analysis to inform clinical guidelines",
"author": "Bryant A",
"doi-asserted-by": "publisher",
"journal-title": "Am J Ther",
"key": "ref26",
"unstructured": "Bryant A, Lawrie TA, Dowswell T, Fordham EJ, Mitchell S, Hill SR, Tham TC. Ivermectin for prevention and treatment of COVID-19 infection: a systematic review, meta-analysis, and trial sequential analysis to inform clinical guidelines. Am J Ther. 2021, 28:e434-60. 10.1097/MJT.0000000000001402",
"volume": "28",
"year": "2021"
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"DOI": "10.31083/j.rcm2202033",
"article-title": "A case of COVID-19 infection quickly relieved after nasal instillations and gargles with povidone iodine",
"author": "Blasi C",
"doi-asserted-by": "publisher",
"journal-title": "Rev Cardiovasc Med",
"key": "ref27",
"unstructured": "Blasi C. A case of COVID-19 infection quickly relieved after nasal instillations and gargles with povidone iodine. Rev Cardiovasc Med. 2021, 22:269-70. 10.31083/j.rcm2202033",
"volume": "22",
"year": "2021"
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"DOI": "10.31744/einstein_journal/2021CE6419",
"article-title": "Use of mouthwashes in the management of COVID-19 patients in intensive care units: recommendations and current evidence",
"author": "Tovani-Palone MR",
"doi-asserted-by": "publisher",
"journal-title": "Einstein (Sao Paulo)",
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"unstructured": "Tovani-Palone MR, Shamsoddin E. Use of mouthwashes in the management of COVID-19 patients in intensive care units: recommendations and current evidence. Einstein (Sao Paulo). 2021, 19:eCE6419. 10.31744/einstein_journal/2021CE6419",
"volume": "19",
"year": "2021"
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"DOI": "10.1016/j.dsx.2021.05.019",
"article-title": "Mucormycosis in COVID-19: a systematic review of cases reported worldwide and in India",
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"journal-title": "Diabetes Metab Syndr",
"key": "ref29",
"unstructured": "Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: a systematic review of cases reported worldwide and in India. Diabetes Metab Syndr. 2021, 15:102146. 10.1016/j.dsx.2021.05.019",
"volume": "15",
"year": "2021"
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"DOI": "10.1016/j.mycmed.2017.11.006",
"article-title": "Povidone iodine soaked gelfoam for the treatment of recalcitrant otomycosis - our experiences at a tertiary care teaching hospital of eastern India",
"author": "Swain SK",
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