Factors affecting death due to COVID-19: an analytical study from a tertiary care hospital of Assam
DOI:
https://doi.org/10.18203/2320-6012.ijrms20232111Keywords:
Assam, Comorbidity, CKD, Diabetes, Hypertension, CoVID-19Abstract
Background: Globally, the Case Fatality Rate (CFR) due CoVID19 ranges from 0.1-4.7%. CoVID-19 death remained 0.5% till April 2021 in Assam as compared to India (1.3%). Though pre-existing diseases greatly contributes to CFR yet its association study from India is scarce. This study documents association of such death with comorbidities in a tertiary hospital of Assam.
Methods: Retrospective analysis of 234 COVID death from May 2020 to December 2020 in Jorhat Medical College (JMCH) were done. Demography, comorbidities at admission and blood parameters were analyzed in Epi-Info version7.2.4.0. Continuous variables were presented as mean±SD or median (interquartile ranges) and correlated with death.
Results: Out of 3781 confirmed cases admitted in JMCH, 234 died (72% male) with CFR of 0.06. Highest deaths occurred between 61 to 70 years. Median duration of disease was 4 days (IQR 2-8days). Acute respiratory distress or pneumonia was most common (53.1%) symptom followed by septicemia (24.6%) at admission. Diabetes mellitus (36.6%), hypertension (24.8%), diabetes with hypertension (11.4%) and chronic kidney diseases (22.4%) were common chronic comorbidities. About 64% cases had thrombocytopenia, and 66.9% had leukocytosis at admission. Many cases had coronary artery diseases, left ventricular failure, post-operative complications, post-partum complications, severe hemoptysis, severe anemia, metabolic encephalopathy, acute myocardial infarction, non-ketotic coma and acute gastroenteritis and SARS-COV2 infection.
Conclusions: CoVID19 associated mortality in Assam was low and mostly among elderly with chronic comorbidities. CKD was most significantly associated with mortality. Superimposed bacterial infection at admission contributed to many fatal outcomes in COVID19, thus warranting proper empirical antibiotic.
References
Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. Jama. 2020;323(16):1574-81.
Bartlett RH, Ogino MT, Brodie D, McMullan DM, Lorusso R, MacLaren G, et al. Initial ELSO guidance document: ECMO for COVID-19 patients with severe cardiopulmonary failure. Asaio Journal. 2020;66(5):472.
Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, Hosein Z, Padda I, Mangat J, Altaf M. Comorbidity and its impact on patients with COVID-19. SN Comprehensive Clinical Medicine. 2020;2:1069-76.
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020 Apr 7;323(13):1239-42.
Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN. Cardiovascular disease, drug therapy, and mortality in Covid-19. New England Journal of Medicine. 2020;382(25):e102.
Elezkurtaj S, Greuel S, Ihlow J, Michaelis EG, Bischoff P, Kunze CA, et al. Causes of death and comorbidities in hospitalized patients with COVID-19. Scientific Reports. 2021;11(1):1-9.
Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. European Respiratory Journal. 20201;55(5).
Johns Hopkins University of Medicine. New cases of COVID-19 in world countries. Available at: https://ccp.jhu.edu/kap-covid. Accessed on 16 July 2021.
Upadhyay AK, Shukla S. Correlation study to identify the factors affecting COVID-19 case fatality rates in India. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2021;15(3):993-9.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020;395(10229):1054-62.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
The Sex, Gender, and COVID-19 Project. The COVID-10 sex-disaggregated data tracker. Available at: https://globalhealth5050.org/covid19/. Accessed on 18 Sept 2020.
Joe W, Kumar A, Rajpal S, Mishra US, Subramanian SV. Equal risk, unequal burden? Gender differentials in COVID-19 mortality in India. J Glob Health Sci. 2020;14(2):1.
Dr Annie Wong-Beringer and colleagues, University of Southern California (USC) School of Pharmacy, Los Angeles, CA, USA. Shorter time from symptom onset to hospitalization is associated with worse outcome in patients with COVID-19. European Society of Clinical Microbiology and Infectious diseases, News release 25-Sep-2020. Available at: https://medicalxpress.com/news/2020-09-shorter-symptom-onset-hospitalization-worse.html. Accessed on 2 March 2023.
Zafer MM, El-Mahallawy HA, Ashour HM. Severe COVID-19 and sepsis: immune pathogenesis and laboratory markers. Microorganisms. 2021;9(1):159.
Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA internal medicine. 2020;180(7):934-43.
Barron E, Bakhai C, Kar P, Weaver A, Bradley D, Ismail H, Knighton P, Holman N, Khunti K, Sattar N, Wareham NJ. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. The lancet Diabetes & endocrinology. 2020;8(10):813-22.
Petrilli CM, Jones SA, Yang J, Rajagopalan H, O’Donnell L, Chernyak Y, Tobin KA, Cerfolio RJ, Francois F, Horwitz LI. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369.
Covid C, Team R, Chow N, Fleming-Dutra K, Gierke R, Hall A, et al. Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019-United States, February 12–March 28, 2020. Morbidity and Mortality Weekly Report. 2020;69(13):382.
Zhang S, Liu Y, Wang X, Yang L, Li H, Wang Y, et al. SARS-CoV-2 binds platelet ACE2 to enhance thrombosis in COVID-19. Journal of Hematology Oncology. 2020;13(1):1-22.
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. New England Journal of Medicine. 2020;382(18):1708-20.
Yamada T, Wakabayashi M, Yamaji T, Chopra N, Mikami T, Miyashita H, et al. Value of leukocytosis and elevated C-reactive protein in predicting severe coronavirus 2019 (COVID-19): A systematic review and meta-analysis. Clinica Chimica Acta. 2020;509:235-43.
