Predisposing factors associated with the severity of the illness in adults with Covid-19 in Nepal

Objective

We aimed to determine the prevalence of the severity of COVID-19 illness and its associated predisposing factors in Nepal.

Design

Cross-sectional, observational study

Setting

Single-centered hospital-based study, conducted at Nepal armed police force (APF) hospital, Kathmandu, Nepal.

Participants

All individuals aged ≥18 years with laboratory-confirmed SARS-Cov-2 (the SARS-CoV-2 specific real-time-RT-PCR result positive), regardless the severity of their disease.

Measurements

Disease severity was evaluated as a primary outcome and age, sex, BMI, smoking history, alcohol history, Hypertension, diabetes mellitus were evaluated as predictors in the analysis.

Results

Mean ages of the patients were 40.79±16.04 years, and about two-thirds of the patients were male 146 (73.7%). More than half 57.1% (95%CI: 52.42-61.51) of the population had a mild infection, whereas 16.7% (95%CI: 7.4-24.6%) had severe/critical illness. In univariate analysis, each 1-year increase in age (OR: 1.05; 95% CI:1.030-1.081; P<0.001), each 1 unit increase in BMI (OR:1.12; 95% CI:1.02-1.25; P=0.033), comorbid illness (OR: 5.79; 95%CI: 2.51-13.33; P<0.001), hypertension (OR:5.95; 95%CI:2.66-13.30: P<0.001), diabetes mellitus (OR:3.26; 95%CI:1.30-8.15: P<0.005), and fever (OR:34.64; 95% CI:7.98-150.38; P<0.001) were independently associated with severity of the disease, whereas age (OR: 1.049; 95% CI: 1.019-1.080; P=0.02), hypertension (OR: 4.77; 95%CI: 1.62-14.04; P=0.004), and fever (OR: 51.02; 95%CI: 9.56-272.51; P<0.001) remained a significant predictive factors in multivariate analysis.

Conclusion

The majority of the patients with COVID-19 had a mild illness, with 16.7% severe illness. Age, BMI, hypertension, diabetes mellitus, comorbidity, and temperature were associated the severity of the illness. Age, hypertension, and fever emerged as an independent predictive factors in multivariate analysis, and thus, these vulnerable groups should be given special protection to the infection and proactive intervention should be initiated at an early stage of the infection to diminish the severity of the illness and improve the clinical outcome of the disease.

Strengths and limitations of the study

• Much of the studies on COVID-19 in Nepal focus on the describing epidemiology and clinical profile of the disease, however, risk factors that contribute to the severity of the illness are overlooked.

• This study may help estimate the burden of the disease and identify the vulnerable group with poor prognosis, which is vital for clinicians and the public health approach to deal with the disease.

• Although limiting the study to a single-center with a relatively small sample size, it, however, allows evaluation of the importance of the demographic and geographical variation.

• Socio-economic factors, lifestyle, and availability of quality medical care may have contributed to the severity of the COVID-19, which needs to be addressed in a further large-scale study.