Predictors of critical illness and mortality based on symptoms and initial physical examination for patients with SARS-CoV-2: A retrospective cohort study

Bairwa, Mukesh; Kumar, Rajesh; Ajmal, Mohammed; Bahurupi, Yogesh; Kant, Ravi

doi:10.1016/j.jiph.2021.06.010

Cited by 8 publications

(6 citation statements)

References 32 publications

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“…Our findings were different from the study by Chauhan et al 5 that showed more proportion of fever, fatigue, myalgia, abdominal pain in those who died as compared to those who survived. However, the study by Bairwa et al 6 concurred with the clinical symptomatology of our study. The case fatality rate of our cohort was 19.5% which was similar to that in multiple other studies.…”

Section: Discussionsupporting

confidence: 93%

Clinical features, demography and predictors of outcomes of SARS-CoV-2 infection in a tertiary care hospital in India-A cohort study

Elavarasi

Sagiraju

Garg

et al. 2021

Preprint

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Background The second wave of the COVID-19 pandemic hit India from early April 2021 to June 2021 and more than 400,000 cases per day were reported in the country. We describe the clinical features, demography, treatment trends, baseline laboratory parameters of a cohort of patients admitted at the All India Institute of Medical Sciences, New Delhi with SARS-CoV-2 infection and their association with the outcome. Methods This was a retrospective cohort study describing the clinical, laboratory and treatment patterns of consecutive patients admitted with SARS-CoV-2 infection. Multivariate logistic regression models were fitted to identify the clinical and biochemical predictors of developing hypoxia, deterioration during the hospital stay and death. Findings A total of 2080 patients were included in the study. The case fatality rate was 19.5%. Amongst the survivors, the median duration of hospital stay was 8 (5-11) days. Out of 853 (42.3%%) of patients who had COVID-19 Acute respiratory distress syndrome at presentation, 340 (39.9%) died. Patients aged 45-60 years [OR (95% CI): 1.8 (1.2-2.6)p =0.003] and those aged >60 years [OR (95%CI): 3.4 (2.3-5.2), p<0.001] had a higher odds of death as compared to the 18-44 age group. Vaccination reduced the odds of death by 30% [OR (95% CI): 0.7 (0.5-0.9), p=0.036]. Patients with hyper inflammation at baseline as suggested by leucocytosis [OR (95% CI): 2.1 (1.4-3.10), p <0.001], raised d-dimer >500 mg/dL [OR (95% CI): 3.2 (2.2-4.6), p <0.001] and raised C-reactive peptide >0.5 mg/L [OR (95% CI): 3.8 (1.1-13), p=0.037] had higher odds of death. Patients who were admitted in the second week had lower odds of death and those admitted in the third week had higher odds of death. Interpretation This is the largest cohort of patients admitted with COVID-19 from India reported to date and has shown that vaccination status and early admission during the inflammatory phase can change the course of illness of these patients. Strategies should be made to improve vaccination rates and early admission of patients with moderate and severe COVID-19 to improve outcomes.

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Section: Discussionsupporting

confidence: 93%

Clinical features, demography and predictors of outcomes of SARS-CoV-2 infection in a tertiary care hospital in India-A cohort study

Elavarasi

Sagiraju

Garg

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…However, the study by Bairwa et al . [ 7 ] concurred with the clinical symptomatology of our study. The case-fatality rate of our cohort was 19.5% which was similar to that in multiple other studies.…”

Section: Discussionsupporting

confidence: 91%

“…The case-fatality rate of our cohort was 19.5% which was similar to that in multiple other studies. [ 6 7 8 9 10 ] Another cohort from our center during the “first wave” of the pandemic reported a case-fatality rate of 1.4%. [ 11 ] However, a study from a tertiary care hospital in New Delhi reported a CFR of 28.3%.…”

Section: Discussionmentioning

confidence: 99%

Clinical features, demography, and predictors of outcomes of SARS-CoV-2 infection at a tertiary care hospital in India: A cohort study

et al. 2021

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Background: The “second wave” of the COVID-19 pandemic hit India from early April 2021 to June 2021. We describe the clinical features, treatment trends, and baseline laboratory parameters of a cohort of patients with SARS-CoV-2 infection and their association with the outcome. Methods: This was a retrospective cohort study. Multivariate logistic regression models were fitted to identify clinical and biochemical predictors of developing hypoxia, deterioration during the hospital stay, and death. Results: A total of 2080 patients were included. The case fatality rate was 19.5%. Among the survivors, the median duration of hospital stay was 8 (5–11) days. Out of 853 (42.3%%) of patients who had COVID-19 acute respiratory distress syndrome at presentation, 340 (39.9%) died. Patients aged >45 years had higher odds of death as compared to the 18–44 years age group. Vaccination reduced the odds of death by 40% (odds ratio [OR] [95% confidence interval [CI]]: 0.6 [0.4–0.9], P = 0.032). Patients with hyper inflammation at baseline as suggested by leukocytosis (OR [95% CI]: 2.1 [1.5–3.1], P < 0.001), raised d-dimer >500 mg/dL (OR [95% CI]: 3.2 [2.2–4.7], P < 0.001), and raised C-reactive peptide >0.5 mg/L (OR [95% CI]: 3.7 [2.2–13], P = 0.037) had higher odds of death. Patients who were admitted in the 2 nd week had lower odds and those admitted in the 3 rd week had higher odds of death. Conclusion: This study shows that vaccination status and early admission during the inflammatory phase can change the course of illness of these patients. Improving vaccination rates and early admission of patients with moderate and severe COVID-19 can improve the outcomes.

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“… 14 , 20 An SpO 2 value ≤ 94% at the time of admission was also associated with higher odds of mortality; similar results were found in other studies as well. 9 , 17 , 21 We found a strong association between difficulty breathing at the time of admission and mortality, although the presence of a cough and fever was not significantly associated. Most of the studies conducted across different settings found a positive association between breathlessness at the time of admission and mortality 8 , 16 , 17 , 21 ; however, evidence regarding cough is conflicting.…”

Section: Discussionmentioning

confidence: 60%

Predictors of Mortality among Patients Hospitalized with COVID-19 during the First Wave in India: A Multisite Case-Control Study

Krishnan

Kumar

Amarchand

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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Severe acute respiratory syndrome coronavirus 2 disease (COVID-19) has caused more than 6 million deaths globally. Understanding predictors of mortality will help in prioritizing patient care and preventive approaches. This was a multicentric, unmatched, hospital-based case-control study conducted in nine teaching hospitals in India. Cases were microbiologically confirmed COVID-19 patients who died in the hospital during the period of study and controls were microbiologically confirmed COVID-19 patients who were discharged from the same hospital after recovery. Cases were recruited sequentially from March 2020 until December–March 2021. All information regarding cases and controls was extracted retrospectively from the medical records of patients by trained physicians. Univariable and multivariable logistic regression was done to assess the association between various predictor variables and deaths due to COVID-19. A total of 2,431 patients (1,137 cases and 1,294 controls) were included in the study. The mean age of patients was 52.8 years (SD: 16.5 years), and 32.1% were females. Breathlessness was the most common symptom at the time of admission (53.2%). Increasing age (adjusted odds ratio [aOR]: 46–59 years, 3.4 [95% CI: 1.5–7.7]; 60–74 years, 4.1 [95% CI: 1.7–9.5]; and ≥ 75 years, 11.0 [95% CI: 4.0–30.6]); preexisting diabetes mellitus (aOR: 1.9 [95% CI: 1.2–2.9]); malignancy (aOR: 3.1 [95% CI: 1.3–7.8]); pulmonary tuberculosis (aOR: 3.3 [95% CI: 1.2–8.8]); breathlessness at the time of admission (aOR: 2.2 [95% CI: 1.4–3.5]); high quick Sequential Organ Failure Assessment score at the time of admission (aOR: 5.6 [95% CI: 2.7–11.4]); and oxygen saturation < 94% at the time of admission (aOR: 2.5 [95% CI: 1.6–3.9]) were associated with mortality due to COVID-19. These results can be used to prioritize patients who are at increased risk of death and to rationalize therapy to reduce mortality due to COVID-19.

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Predictors of critical illness and mortality based on symptoms and initial physical examination for patients with SARS-CoV-2: A retrospective cohort study

Cited by 8 publications

References 32 publications

Clinical features, demography and predictors of outcomes of SARS-CoV-2 infection in a tertiary care hospital in India-A cohort study

Clinical features, demography and predictors of outcomes of SARS-CoV-2 infection in a tertiary care hospital in India-A cohort study

Clinical features, demography, and predictors of outcomes of SARS-CoV-2 infection at a tertiary care hospital in India: A cohort study

Predictors of Mortality among Patients Hospitalized with COVID-19 during the First Wave in India: A Multisite Case-Control Study

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