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

  1. Arunmozhimaran Elavarasi
  2. Hari Krishna Raju Sagiraju
  3. Rohit Kumar Garg
  4. Brajesh Ratre
  5. Prashant Sirohiya
  6. Nishkarsh Gupta
  7. Rakesh Garg
  8. Anuja Pandit
  9. Saurabh Vig
  10. Ram Singh
  11. Balbir Kumar
  12. Ved Prakash Meena
  13. Naveet Wig
  14. Saurabh Mittal
  15. Sourabh Pahuja
  16. Karan Madan
  17. Randeep Guleria
  18. Anant Mohan
  19. Tanima Dwivedi
  20. Ritu Gupta
  21. Ashima Jain Vidyarthi
  22. Rama Chaudhry
  23. Arghya Das
  24. LaxmiTej Wundavalli
  25. Angel Rajan Singh
  26. Sheetal Singh
  27. Sunil Kumar
  28. Manisha Pandey
  29. Abhinav Mishra
  30. Karanvir Singh Matharoo
  31. Sushma Bhatnagar

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Abstract

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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  1. Version published to 10.4103/lungindia.lungindia_493_21
  2. Version published to 10.1101/2021.08.10.21261855v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.08.10.21261855: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The study protocol was approved by the Institutional review board.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, it has a few limitations. Due to the retrospective nature of the data collection, few files had been misplaced or lost and nearly 10% of data points were missing. However, due to the large sample size of 2080 patients, we were able to find several independent risk factors for these outcomes. Similarly, due to the observational nature of the study, it is not possible to draw conclusions regarding causation. It is difficult to comment on the efficacy of for example high dose methylprednisolone pulses in preventing in-hospital deterioration because the drug had been administered at varying time points in the patients rather than a protocolized administration. In some patients, it had been administered once they needed oxygen administered through a high-flow nasal cannula while in others it was administered while on the verge of respiratory failure needing non-invasive ventilation. Similarly, the treatment was decided by the individual clinicians based on their discretion and thus subject to confounding by indication, thus precluding definite causation from being inferred. Other inflammatory markers such as raised ferritin and IL-6 were also associated with increased odds of death, however, due to the low number of patients in whom these parameters were available at baseline, it was not included in the logistic regression models.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  4. Version published to 10.1101/2021.08.10.21261855v1 on medRxiv