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Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India

OBJECTIVES: Primary objective was to study the clinicodemographic profile of hospitalised COVID-19 patients at a tertiary-care centre in India. Secondary objective was to identify predictors of poor outcome. SETTING: Single centre tertiary-care level. DESIGN: Retrospective cohort study. PARTICIPANTS...

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Autores principales: Tiwari, Lokesh, Gupta, Prakriti, N, Yankappa, Banerjee, Amrita, Kumar, Yogesh, Singh, Prashant K, Ranjan, Alok, Singh, C M, Singh, Prabhat Kumar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9160596/
https://www.ncbi.nlm.nih.gov/pubmed/35649611
http://dx.doi.org/10.1136/bmjopen-2021-056464
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author Tiwari, Lokesh
Gupta, Prakriti
N, Yankappa
Banerjee, Amrita
Kumar, Yogesh
Singh, Prashant K
Ranjan, Alok
Singh, C M
Singh, Prabhat Kumar
author_facet Tiwari, Lokesh
Gupta, Prakriti
N, Yankappa
Banerjee, Amrita
Kumar, Yogesh
Singh, Prashant K
Ranjan, Alok
Singh, C M
Singh, Prabhat Kumar
author_sort Tiwari, Lokesh
collection PubMed
description OBJECTIVES: Primary objective was to study the clinicodemographic profile of hospitalised COVID-19 patients at a tertiary-care centre in India. Secondary objective was to identify predictors of poor outcome. SETTING: Single centre tertiary-care level. DESIGN: Retrospective cohort study. PARTICIPANTS: Consecutively hospitalised adults patients with COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome variable was in-hospital mortality. Covariables were known comorbidities, clinical features, vital signs at the time of admission and on days 3–5 of admission, and initial laboratory investigations. RESULTS: Intergroup differences were tested using χ(2) or Fischer’s exact tests, Student’s t-test or Mann-Whitney U test. Predictors of mortality were evaluated using multivariate logistic regression model. Out of 4102 SARS-CoV-2 positive patients admitted during 1-year period, 3268 (79.66%) survived to discharge and 834 (20.33%) died in the hospital. Mortality rates increased with age. Death was more common among males (OR 1.51, 95% CI 1.25 to 1.81). Out of 261 cases analysed in detail, 55.1% were in mild, 32.5% in moderate and 12.2% in severe triage category. Most common clinical presentations in the subgroup were fever (73.2%), cough/coryza (65.5%) and breathlessness (54%). Hypertension (45.2%), diabetes mellitus (41.8%) and chronic kidney disease (CKD; 6.1%) were common comorbidities. Disease severity on admission (adjusted OR 12.53, 95% CI 4.92 to 31.91, p<0.01), coagulation defect (33.21, 3.85–302.1, p<0.01), CKD (5.67, 1.08–29.64, p=0.04), high urea (11.05, 3.9–31.02, p<0.01), high prothrombin time (3.91, 1.59–9.65, p<0.01) and elevated ferritin (1.02, 1.00–1.03, p=0.02) were associated with poor outcome on multivariate regression. A strong predictor of mortality was disease progression on days 3–5 of admission (adjusted OR 13.66 95% CI 3.47 to 53.68). CONCLUSION: COVID-19 related mortality in hospitalised adult patients at our center was similar to the developed countries. Progression in disease severity on days 3–5 of admission or days 6–13 of illness onset acts as ‘turning point’ for timely referral or treatment intensification for optimum use of resources.
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spelling pubmed-91605962022-06-02 Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India Tiwari, Lokesh Gupta, Prakriti N, Yankappa Banerjee, Amrita Kumar, Yogesh Singh, Prashant K Ranjan, Alok Singh, C M Singh, Prabhat Kumar BMJ Open Global Health OBJECTIVES: Primary objective was to study the clinicodemographic profile of hospitalised COVID-19 patients at a tertiary-care centre in India. Secondary objective was to identify predictors of poor outcome. SETTING: Single centre tertiary-care level. DESIGN: Retrospective cohort study. PARTICIPANTS: Consecutively hospitalised adults patients with COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome variable was in-hospital mortality. Covariables were known comorbidities, clinical features, vital signs at the time of admission and on days 3–5 of admission, and initial laboratory investigations. RESULTS: Intergroup differences were tested using χ(2) or Fischer’s exact tests, Student’s t-test or Mann-Whitney U test. Predictors of mortality were evaluated using multivariate logistic regression model. Out of 4102 SARS-CoV-2 positive patients admitted during 1-year period, 3268 (79.66%) survived to discharge and 834 (20.33%) died in the hospital. Mortality rates increased with age. Death was more common among males (OR 1.51, 95% CI 1.25 to 1.81). Out of 261 cases analysed in detail, 55.1% were in mild, 32.5% in moderate and 12.2% in severe triage category. Most common clinical presentations in the subgroup were fever (73.2%), cough/coryza (65.5%) and breathlessness (54%). Hypertension (45.2%), diabetes mellitus (41.8%) and chronic kidney disease (CKD; 6.1%) were common comorbidities. Disease severity on admission (adjusted OR 12.53, 95% CI 4.92 to 31.91, p<0.01), coagulation defect (33.21, 3.85–302.1, p<0.01), CKD (5.67, 1.08–29.64, p=0.04), high urea (11.05, 3.9–31.02, p<0.01), high prothrombin time (3.91, 1.59–9.65, p<0.01) and elevated ferritin (1.02, 1.00–1.03, p=0.02) were associated with poor outcome on multivariate regression. A strong predictor of mortality was disease progression on days 3–5 of admission (adjusted OR 13.66 95% CI 3.47 to 53.68). CONCLUSION: COVID-19 related mortality in hospitalised adult patients at our center was similar to the developed countries. Progression in disease severity on days 3–5 of admission or days 6–13 of illness onset acts as ‘turning point’ for timely referral or treatment intensification for optimum use of resources. BMJ Publishing Group 2022-06-01 /pmc/articles/PMC9160596/ /pubmed/35649611 http://dx.doi.org/10.1136/bmjopen-2021-056464 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Global Health
Tiwari, Lokesh
Gupta, Prakriti
N, Yankappa
Banerjee, Amrita
Kumar, Yogesh
Singh, Prashant K
Ranjan, Alok
Singh, C M
Singh, Prabhat Kumar
Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India
title Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India
title_full Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India
title_fullStr Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India
title_full_unstemmed Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India
title_short Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India
title_sort clinicodemographic profile and predictors of poor outcome in hospitalised covid-19 patients: a single-centre, retrospective cohort study from india
topic Global Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9160596/
https://www.ncbi.nlm.nih.gov/pubmed/35649611
http://dx.doi.org/10.1136/bmjopen-2021-056464
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