CLINICAL PROFILES AND OUTCOMES OF PATIENTS ADMITTED WITH MODERATE TO CRITICAL CORONAVIRUS DISEASE 2019 (COVID-19)
Keywords:Noninvasive ventilation, Mechanical Ventilation, Critical Disease, Acute Respiratory Distress Syndrome, Cytokine Release Syndrome, SARS-CoV-2
Objective: To evaluate various demographic, clinical, radiological and hematological manifestations of moderate to critical coronavirus disease 2019 (COVID-19) and to assess its complications and outcomes in the Pakistani population.
Study Design: Retrospective observational study.
Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Apr to Jul 2020.
Methodology: Demographic, clinical, radiological and hematological data of 600 consecutive patients were retrieved and analyzed from hospital registry.
Results: Overall, 449 (74.8%) patients had at least 1 comorbidity, diabetes mellitus being commonest; 228 (38%) [95% CI, 34.1- 42%]. The most common symptoms were cough; 451 (75.2%), fever; 450 (75%) and shortness of breath; 419 (69.8%). At presentation, 222 (37%) patients had moderate disease, 296 (49.3%) severe and 82 (12.7%) had critical disease. At admission, 277 (46.2%) patients required respiratory support and further 185 (30.8%) patients required treatment escalation later on correlated with disease severity and age (p<0.001). A total of 92 (15.3%) patients died out of which 38 (21.2%) were on noninvasive ventilation and 36 (66.6%) on invasive ventilation, (p<0.001). Overall survival (OS) was 84.7%; log rank <0.001. Mortality was highest in critical disease, 72 (31.3%) (p<0.001). A majority of patients, 440 (73.3%) developed complications, the most common
being Cytokine release storm (CRS); 57.5% respiratory failure; 43.8% and Acute respiratory distress syndrome (ARDS); 38.8%. Thrombotic events occurred in 106 (17.6%).
Conclusion: Majority of patients with moderate to severe COVID-19 had comorbidities and ended up in various