Severity Index and Outcome of Hospitalized COVID-19 Patients in Capital Hospital, CDA, Islamabad
Objective: To assess clinical characteristics and outcome of patients with Covid-19 infection.
Study design: Descriptive cross-sectional study.
Place and duration of study: Department of Medicine, Capital Hospital Islamabad from February 01, 2021 to April 25, 2021.
Methodology: A manual medical record of total of 221 patients was conducted, more than 18 years of age, both genders, who presented with features suggestive of Covid-19 infection were included. Patients were tested for COVID-19 PCR, blood complete picture and inflammatory markers. The data was analyzed by using SPSS version 42.
Results: Among 221 patients, there were 125(56.6%) males and 96(43.4%) females. Mean age was 57.20+13.17 years. Total 155(70%) cases were Covid PCR +ve and 66(30%) –ve. 86(38.9%) cases had mild, 91(41.2%) had moderate and 44(19.9%) had severe covid-19 infection. Lymphopenia was observed in 154(69.7%) cases. C-reactive protein was positive in 178(80.5%) cases. Serum ferritin was raised in 114(51.5%) cases, D-dimers in 139(66.9%), lactic dehydrogenase in 167(75.5%) cases with significant association with disease severity. Serum interleukin, performed in moderate and severe cases only, had mean value of 54.1+105.94pg/ml. Diabetes mellitus was found significantly associated with mortality (p=0.007) as well as hypertension (p<0.0001). 207 cases were managed and discharged, 14 cases expired (6.33%). Mortality was significantly associated with disease severity (p<0.001). Remdesivir was given to symptomatic patients and 94.4 % patients were discharged vs 5.6 % expired. Remdesivir and tocilizumab was given in combination in severe/critical patients and 76.5% patients were discharged vs 23.5% expired.
Conclusion: Covid-19 is a disease with variable presentations. Severity of Covid-19 infection is directly related to lymphopenia as well as inflammatory markers. IL-6 levels, raised in more severe cases, signify immune response to Covid-19. Disease is more severe in patients with comorbids. In moderate to severe disease remdesivir and in severe covid disease with high IL-6 levels combination of antiviral and tocilizumab may help to improve outcome.
2 McIntosh K, Hirsch MS, Bloom A. Coronavirus disease 2019 (COVID-19): Epidemiology, virology, and prevention. Lancet. Infect. Dis. 2020 Jul;1:2019-20.
3 Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, Azman AS, Reich NG, Lessler J. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Annals of internal medicine. 2020 May 5;172(9):577-82.
4 Stephen A. Lauer, Kyra H. Grantz, Qifang Bi, Forrest K. Jones, Qulu Zheng, Hannah R. Meredith, Andrew S. Azman. "The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application." Annals of Internal Medicine (2020): 577-582.
5 Belouzard S, Millet JK, Licitra BN, Whittaker GR. Mechanisms of coronavirus cell entry mediated by the viral spike protein. Viruses. 2012 Jun;4(6):1011-33. (Belouzard S, 2012)
6 Long C, Xu H, Shen Q, Zhang X, Fan B, Wang C, Zeng B, Li Z, Li X, Li H. Diagnosis of the Coronavirus disease (COVID-19): rRT-PCR or CT?. European journal of radiology. 2020 May 1;126:108961
7 Yuan X, Huang W, Ye B, Chen C, Huang R, Wu F, Wei Q, Zhang W, Hu J. Changes of hematological and immunological parameters in COVID-19 patients. International journal of hematology. 2020 Oct;112(4):553-9
8. Terpos E, Ntanasis‐Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, Psaltopoulou T, Gerotziafas G, Dimopoulos MA. Hematological findings and complications of COVID‐19. American journal of hematology. 2020 Jul;95(7):834-47.
9. Sarma P, Prajapat M, Avti P, Kaur H, Kumar S, Medhi B. Therapeutic options for the treatment of 2019-novel coronavirus: An evidence-based approach. Indian journal of pharmacology. 2020 Jan;52(1):1
10. Wang, D. et al. Clinical characteristics of 138 hospitalized patients with 21019 noval Corona virus infected pneumonia in Wuhan, CHINA. JAMA 323, 1061-1069(2020).
11 Kyung-Bok Son, Tae-jin Lee, et al. Disease severity classification and COVID-19 outcomes, Republic of Korea. Bull World Health Organ. 2021 Jan1;99(1):62-66.
12. Lee DW, Gardner R, Porter DL, et al. Current concepts in the diagnosis and management of cytokine release syndrome. Blood 2014;124:188-195.
13. Herald T, et al. Elevated levels of Interleukin-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy clin immunol.2020. doi:10-1016/j-jaci.2020.05.008
14 Xu, H. et al. High expression of ACE 2 receptor of 2019-nCov on the epithelial cells of oral mucosa. Int J, Oral. Sci. 12,8(2020)
15 Li Tan, et al. Signal transduction and targeted therapy 5, Article number: 33(2020).
16 Vargas-Vargas M, Cortes-Rojo C, Ferritin levels and COVID-19, Rev Panam Salud Publica. 2020; 44:e72.
17 Hai-Han Yu, et al. D-dimer level is associated with severity of COVID-19 infection. Thromb Res. 2020 No; 195:219-225.
18 Brandon Michael Henry et al, Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis. Am J Emerge Med.2020 Sep;38(a):1722-1726.
19 Bischof, E et al towards Precision Medicine Inclusion of Sex and Gender Aspects in COVID-19 clincal studies. Acting Now before it is Too Late.A joint call for action. Int J. Environ.Res Public health, 17, 3715(2020).
20 Hanang, C. etal. Clinical feature of patients infected with 2019 novel Coronavirus in Wuhan, China. Lancet 395, 497-506(2020).
21 Vardan Nersesjan et al. Thirty day morbidity and mortality in COVID-19 positive vs COVID-19 negative individuals and vs individuals tested for influenza A/B; A population based study. Front Med (Lansanre).2020; 7:598-272
22 Beigel J, Tomashek K, Dodd LE, et al. Remdesivir for the treatment of covid-19- final report. N Engl Med 2020 Oct 8.
23 Carlos Salama, Linda YAU et al. Tocilizumab in Patients Hospitalized with Covid 19 Pneumonia. N Engl J Med2021;384:20-30
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