Presenting Characteristics, Comorbidities, and Outcomes Among Patients With COVID-19 Hospitalized in Pakistan: Retrospective Observational Study

Abstract

Background COVID-19 became a pandemic rapidly after its emergence in December 2019. It belongs to the coronavirus family of viruses, which have struck a few times before in history. Data based on previous research regarding etiology and epidemiology of other viruses from this family helped played a vital role in formulating prevention and precaution strategies during the initial stages of this pandemic. Data related to COVID-19 in Pakistan were not initially documented on a large scale. In addition, due to a weak health care system and low economic conditions, Pakistan’s population, in general, already suffers from many comorbidities, which can severely affect the outcome of patients infected with COVID-19. Objective COVID-19 infections are coupled with a manifestation of various notable outcomes that can be documented and characterized clinically. The aim of this study was to examine these clinical manifestations, which can serve as indicators for early detection as well as severity prognosis for COVID-19 infections, especially in high-risk groups. Methods A retrospective observational study involving abstraction of demographic features, presenting symptoms, and adverse clinical outcomes for 1812 patients with COVID-19 was conducted. Patients were admitted to the four major hospitals in the Rawalpindi-Islamabad region of Pakistan, and the study was conducted from February to August 2020. Multivariate regression analysis was carried out to identify significant indicators of COVID-19 severity, intensive care unit (ICU) admission, ventilator aid, and mortality. The study not only relates COVID-19 infection with comorbidities, but also examines other related factors, such as age and gender. Results This study identified fever (1592/1812, 87.9%), cough (1433/1812, 79.1%), and shortness of breath (998/1812, 55.1%) at the time of hospital admission as the most prevalent symptoms for patients with COVID-19. These symptoms were common but not conclusive of the outcome of infection. Out of 1812 patients, 24.4% (n=443) required ICU admission and 21.5% (n=390) required ventilator aid at some point of disease progression during their stay at the hospital; 25.9% (n=469) of the patients died. Further analysis revealed the relationship of the presented symptoms and comorbidities with the progression of disease severity in these patients. Older adult patients with comorbidities, such as hypertension, diabetes, chronic kidney disease, and asthma, were significantly affected in higher proportions, resulting in requirement of ICU admission and ventilator aid in some cases and, in many cases, even mortality. Conclusions Older adult patients with comorbidities, such as hypertension, diabetes, asthma, chronic obstructive pulmonary disorder, and chronic kidney disease, are at increased risk of developing severe COVID-19 infections, with an increased likelihood of adverse clinical outcomes.

An Evaluation of Non-Communicable Diseases and Risk Factors Associated with COVID-19 Disease Severity in Dubai, United Arab Emirates: An Observational Retrospective Study

“…Our study also found that COVID-19 severity is strongly influenced by the presence of multiple comorbidities such that once these comorbidities were controlled in the model, the effects of diabetes, thyroid disorders, mental disorders, and behavioral disorders no longer appeared. These findings suggest that an increase in comorbidities is a significant predictor of COVID-19 severity, ICU admission, ventilator assistance, and even mortality-consistent with previous studies [ 64 , 65 ]. Additionally, multiple comorbidities are typically seen in older individuals.…”

Comparative assessment of SARS CoV2-associated mortalities in 3 COVID waves and related risk factors: The South Kashmir’s experience

“…[ 15 ] Similarly, Akhtar et al . [ 16 ] have evinced a remarkable association of comorbidities in the escalation of the disease severity. Among comorbidities associated with SARS-CoV-2–linked complications, 39.7% of hypertension, 37.8% of diabetes, 31.2% of asthma, and 11.1% of COPD were spotted.…”

Estimates of hospitalisations and deaths in patients with COVID-19 associated with undiagnosed diabetes during the first phase of the pandemic in eight low-income and middle-income countries: a modelling study

“… 6 Pakistan 0.294 b Feb–Aug 2020 Four hospitals in Islamabad-Rawalpindi 1812 Akhtar et al. 26 South Africa 0.166 (0.112–0.228) Based on meta-analysis of 12 studies based in African region 10,756 Li et al. 6 a Mean prevalence and 95% confidence interval provided in parentheses.…”