Educational status and COVID-19 related outcomes in India: hospital-based cross-sectional study

Sharma, Arvind; Gupta, Rajeev; Baig, Vaseem Naheed; Singh, Veer Teja; Chakraborty, Surabhi; Sunda, Jagdish P; Dhakar, Prahalad; Sharma, Sanjeev Kumar; Panwar, Raja Babu; Katoch, Vishwa Mohan

doi:10.1136/bmjopen-2021-055403

Cited by 13 publications

(14 citation statements)

References 35 publications

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“…The case-report form was updated and modified from that available at the Regional Covid Care Hospital at local Health Sciences University. 19…”

Section: Methodsmentioning

confidence: 99%

“…The case-report form was updated and modified from that available at the Regional Covid Care Hospital at local Health Sciences University. 19 Patients: All patients presenting to medical and emergency departments with symptoms suggestive of upper respiratory infections were screened with reverse transcriptase-polymerase chain reaction (RT-PCR). Details of the sample collection and testing protocol have been reported.…”

Section: Methodsmentioning

confidence: 99%

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Biomarkers and Outcomes in Hospitalized Covid-19 Patients: A Prospective Registry

Khedar

Gupta

Sharma

et al. 2022

Preprint

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Objectives: To determine association of biomarkers high sensitivity C-reactive protein (hsCRP), D-dimer, interleukin-6 (IL-6), lactic dehydrogenase (LDH), ferritin and neutrophil-lymphocyte ratio (NLR) at hospital admission with clinical features and outcomes in Covid-19. Methods: Successive virologically confirmed Covid-19 patients hospitalized from April 2020 to July 2021 were recruited in a prospective registry. Details of clinical presentation, investigations, management and outcomes were recorded. All the biomarkers were divided into tertiles to determine associations with clinical features and outcomes. Numerical data are presented in median and interquartile range (IQR 25-75). Univariate and multivariate (age, sex, risk factor, comorbidity adjusted) odds ratio (OR) and 95% confidence intervals (CI) were calculated to determine association of deaths with each biomarker. Results: We identified 3036 virologically confirmed Covid-19 patients during the study period, 1215 were hospitalized and included in the present study. Men were 70.0%, aged >60y 44.8%, hypertension 44.8% diabetes 39.6% and cardiovascular disease 18.9%. Median symptom duration was 5 days (IQR 4-7) and SpO2 95% (90-97). Total white cell count was 6.9x103/micro-litre, (5.0-9.8), neutrophils 79.2% (68.1-88.2) and lymphocytes 15.8% (8.7-25.5). Medians (IQR) for biomarkers were hsCRP 6.9 mg/dl (2.2-18.9), D-dimer 464 ng/dl (201-982), IL-6 20.1 ng/dl (6.5-60.4), LDH 284 mg/dl (220-396) and ferritin 351 mg/dl (159-676). Oxygen support at admission was in 38.6%, and non-invasive or invasive ventilatory support in 11.0% and 11.6% respectively. 173 (13.9%) patients died and 15 (1.2%) transferred to hospice care. For each biomarker, those in the second and third tertiles, compared to the first, had worse clinical and laboratory abnormalities, and greater oxygen and ventilatory support. Multivariate adjusted OR (95% CI) for deaths in second and third vs first tertiles, respectively, were for hsCRP 2.29(1.14-4.60) and 13.39(7.23-24.80); D-dimer 3.26(1.31-7.05) and 13.89(6.87-28.27); IL-6 2.61(1.31-5.18) and 10.96(5.88-20.43); ferritin 3.19(1.66-6.11) and 9.13(4.97-16.78); LDH 1.85(0.87-3.97) and 10.51(5.41-20.41); and NLR 3.34(1.62-6.89) and 17.52(9.03-34.00) (p<0.001). Conclusions: In Covid-19, high levels of biomarkers- hsCRP, D-dimer, IL-6, LDH, ferritin and NLR are associated with more severe illness and significantly greater in-hospital mortality. NLR, a simple, widely available and inexpensive investigation provides prognostic information similar to the more expensive biomarkers.

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“…The case-report form was updated and modified from that available at the Regional Covid Care Hospital at local Health Sciences University. 19…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Biomarkers and Outcomes in Hospitalized Covid-19 Patients: A Prospective Registry

Khedar

Gupta

Sharma

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…18 The case report form was updated and modified from that available at the regional COVID-19 care hospital at Health Sciences University. 19 Patients: all patients presenting to medical and emergency departments with symptoms suggestive of upper respiratory infections were screened with reverse transcriptase-PCR (RT-PCR). Details of the sample collection and testing protocol have been reported.…”

Section: Methodsmentioning

confidence: 99%

“…We developed a protocol for admission so that only those patients fulfilling definite clinical criteria were hospitalised 18. The case report form was updated and modified from that available at the regional COVID-19 care hospital at Health Sciences University 19…”

Section: Methodsmentioning

confidence: 99%

Biomarkers and outcomes in hospitalised patients with COVID-19: a prospective registry

Khedar

Gupta

Sharma³

et al. 2022

BMJ Open

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ObjectivesTo determine association of biomarkers—high-sensitivity C reactive protein (hsCRP), D-dimer, interleukin-6 (IL-6), lactic dehydrogenase (LDH), ferritin and neutrophil–lymphocyte ratio (NLR)—at hospitalisation with outcomes in COVID-19.Design and SettingTertiary-care hospital based prospective registry.ParticipantsSuccessive virologically confirmed patients with COVID-19 hospitalised from April 2020 to July 2021 were prospectively recruited. Details of clinical presentation, investigations, management and outcomes were obtained.Primary and secondary outcome measuresAll biomarkers were divided into tertiles to determine associations with clinical features and outcomes. Primary outcome was all-cause deaths and secondary outcome was oxygen requirement, non-invasive and invasive ventilation, dialysis, duration of stay in ICU and hospital. Numerical data are presented in median and interquartile range (IQR 25–75). Univariate and multivariate (age, sex, risk factors, comorbidities, treatments) ORs and 95% CIs were calculated.Results3036 virologically confirmed patients with COVID-19 were detected and 1251 hospitalised. Men were 70.0%, aged >60 years 44.8%, hypertension 44.1%, diabetes 39.6% and cardiovascular disease 18.9%. Median symptom duration was 5 days (IQR 4–7) and oxygen saturation 95% (90%–97%). Total white cell count was 6.9×109/L (5.0–9.8), neutrophils 79.2% (68.1%–88.2%), lymphocytes 15.8% (8.7%–25.5%) and creatinine 0.93 mg/dL (0.78–1.22). Median (IQR) for biomarkers were hsCRP 6.9 mg/dL (2.2–18.9), D-dimer 464 ng/dL (201–982), IL-6 20.1 ng/dL (6.5–60.4), LDH 284 mg/dL (220–396) and ferritin 351 mg/dL (159–676). Oxygen support at admission was in 38.6%, subsequent non-invasive or invasive ventilatory support in 11.0% and 11.6%, and haemodialysis in 38 (3.1%). 173 (13.9%) patients died and 15 (1.2%) transferred to hospice care. For each biomarker, compared with the first, those in the second and third tertiles had more clinical and laboratory abnormalities, and oxygen, ventilatory and dialysis support. Multivariate-adjusted ORs (95% CI) for deaths in second and third versus first tertiles, respectively, were hsCRP 2.24 (1.11 to 4.50) and 12.56 (6.76 to 23.35); D-dimer 3.44 (1.59 to 7.44) and 14.42 (7.09 to 29.30); IL-6 2.56 (1.13 to 5.10) and 10.85 (5.82 to 20.22); ferritin 2.88 (1.49 to 5.58) and 8.19 (4.41 to 15.20); LDH 1.75 (0.81 to 3.75) and 9.29 (4.75 to 18.14); and NLR 3.47 (1.68 to 7.14) and 17.71 (9.12 to 34.39) (p<0.001).ConclusionHigh levels of biomarkers—hsCRP, D-dimer, IL-6, LDH, ferritin and NLR—in COVID-19 are associated with more severe illness and higher in-hospital mortality. NLR, a widely available investigation, provides information similar to more expensive biomarkers.

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“…We conducted a hospital based observational study on patients with laboratory confirmed COVID-19 admitted to a 1200-bed dedicated COVID-19 government hospital (Rajasthan University of Health Sciences Hospital, Jaipur, India) from April to mid-September 2020. Initial data on some of these patients have been reported earlier [15][16][17]. The registry has been approved by the college administration and institutional ethics committee (CDSCO Registration Number: CR/762/Inst/RJ/2015).…”

Section: Methodsmentioning

confidence: 99%

Cardiovascular risk factors and outcomes in COVID-19: A hospital-based study in India

Sharma¹,

Baig²,

Sharma³

et al. 2022

PLOS Glob Public Health

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Background & objectives Presence of cardiovascular (CV) risk factors enhance adverse outcomes in COVID-19. To determine association of risk factors with clinical outcomes in India we performed a study. Methods Successive virologically confirmed adult patients of COVID-19 at a government hospital were recruited at admission and data on clinical presentation and in-hospital outcomes were obtained. The cohort was classified according to age, sex, hypertension, diabetes and tobacco use. In-hospital death was the primary outcome. Logistic regression was performed to compared outcomes in different groups. Results From April to September 2020 we recruited 4645 (men 3386, women 1259) out of 5103 virologically confirmed COVID-19 patients (91.0%). Mean age was 46±18y, hypertension was in 17.8%, diabetes in 16.6% and any tobacco-use in 29.5%. Duration of hospital stay was 6.8±3.7 days, supplemental oxygen was in 18.4%, non-invasive ventilation in 7.1%, mechanical ventilation in 3.6% and 7.3% died. Unadjusted and age-sex adjusted odds ratio(OR) and 95% confidence intervals(CI) for in-hospital mortality, respectively, were: age ≥60y vs <40y, OR 8.47(95% CI 5.87–12.21) and 8.49(5.88–12.25), age 40-59y vs <40y 3.69(2.53–5.38) and 3.66(2.50–5.33), men vs women 1.88(1.41–2.51) and 1.26(0.91–1.48); hypertension 2.22(1.74–2.83) and 1.32(1.02–1.70), diabetes 1.88(1.46–2.43) and 1.16(0.89–1.52); and tobacco 1.29(1.02–1.63) and 1.28(1.00–1.63). Need for invasive and non-invasive ventilation was greater among patients in age-groups 40–49 and ≥60y and hypertension. Multivariate adjustment for social factors, clinical features and biochemical tests attenuated significance of all risk factors. Conclusion Cardiovascular risk factors, age, male sex, hypertension, diabetes and tobacco-use, are associated with greater risk of in-hospital death among COVID-19 patients.

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Educational status and COVID-19 related outcomes in India: hospital-based cross-sectional study

Cited by 13 publications

References 35 publications

Biomarkers and Outcomes in Hospitalized Covid-19 Patients: A Prospective Registry

Biomarkers and Outcomes in Hospitalized Covid-19 Patients: A Prospective Registry

Biomarkers and outcomes in hospitalised patients with COVID-19: a prospective registry

Cardiovascular risk factors and outcomes in COVID-19: A hospital-based study in India

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