This study included 235 consecutive patients admitted at Liaquat University Hospital from April 2020 to September 2020.
In current study there were 187(79.6%) male and 48(20.4 %) female. Our results coincide with that of chen et al and wang et.al with a male predominance (73%) and higher than Jin-jin Zhang with 50,6% male.7,21,22
In a study of 337 patients by Filardo TD et.al comprising 227 male (67.4%) with a median age 58 years.23 Guan W, Ni Z, Hu Y, et in a study of 393 patients 238 (60.6%) were male and the median age was 62.2 years.24
The most prevalent symptoms were fever ,breathlessness, cough, anorexia, fatigue in all 235(100% ) patients.
For the first time Huang et.al in a case series of 41 patients noted fever in 98%, cough in 76% and breathlessness in 55% cases. 25 In a study by Garg S et.al comprising 178 patients dyspnea was found in 143(80%) patients. 26Jain et al. in a meta-analysis of 1813 cases observed cough, fever and fatigue in 70.5%,64.1% and 66,5% patients respectively. 27 Wang D and colleagues in a study comprising 138 patients observed fever in 136 (99%), fatigue 96 (70%) and dry cough in 82 (59%0 patients. 21
In our study at least one comorbidity was present in 114/235 (48.5%) .Diabetes mellitus was present in 88/235 ( 37.4%), Hypertension in 80/235 (34 %) patients. Cardiovascular disease (CVD) in 33/235 ( 14%), Chronic Obstructive Airway Disease ( COPD) in 30 /235 ( 12.8), Obesity in 20 / 235 (8.9%) and renal disease in 14/235 ( 6%) patients.
Fei Zhou et al in a study comprising 191 patients observed hypertension 58 (30% ) patients, diabetes mellitus 36(19%) and coronary heart disease 15(8%).28
Guan WJ et.al in a study comprising 1590 patients noted hypertension as the most prevalent (16.9%) followed by diabetes (8.2%), cardiovascular disease (3.7%) and COPD ( 1.5%). 29 Wu et al observed cardiovascular disease in 10.9%, diabetes in 7.3%, 6.3% chronic respiratory disease and 6 % hypertension among 44672 confirmed cases of COVID-19.30 In a systemic review and meta-analysis comprising 46248 patients observed hypertension in 17 ± 7% patients. 31 Ruan et.al in a study of 150 covid-19 patients observed hypertension in 43% patients and cardiovascular disease in 19%.32 Guozhen Li, and collegues in a retrospective study of 199 patients revealed diabetes in 76/199 (38.1%) whereas 123( 61.9%) were non-diabetic.33 Age > 65 years and obesity were noted as two important factors for admission to hospital by Petrilli CM et.al in an analysis of 4103 confirmed cases of CVID − 19. 34 Zhang J and collegues in their study included 140 patients found at least one comorbity in 90 (68%) patients. In all those patients the most prevalent co-morbidity was hypertension (30%) and diabetes mellitus in 12.1% patients.22
In this study severity of illness according to Gram-Covid Score 18 (7.7%) patients were in low-risk group, 93(39.6%) in moderate risk group and 124 (52.8%) in High risk group.
In a cohort by de Terwangne, C et.al patients were classified according to World Health Organization(WHO) severity classification into mild, moderate ,severe and critical. No patients in milder disease were admitted. Out of 295 patients 125 (42.4%) were in moderate ,69 (23.4%) in severe and 101(34.2%) were critical state. 35 Liang W et al in a cohort study of 1590 patients divided patients into low ,moderate and high risk based on Gram-Covid score. According to this study 1459 ( 91.7%) were in non-critical illness and 131(8.21%) were in critical illness group.17 In a study by Wang D and colleagues in a study of 143 patients revealed mild to moderate severity in 72/143 ( 50.3%) and severe to critical in 71/143(49.6%) cases. 21
In our study the outcome showed 57/235(24.3%) deaths, 107/235 ( 45.5%) had prolong stay in hospital and 71/235(30.2%) recovered and discharged from hospital within two weeks time.
In a study of 337 patients by Filardo TD et.al comprising 227 male (67.4%) with a median age 58 years. The total mortality was 28.9% inclusive of ICU and Non-ICU patients. 36 Guan W, Ni Z, Hu Y, et in a study of 393 patients 238 (60.6%) were male and the median age was 62.2 years. Out of total 393 patients 40 (10.2%) were dead, 260 (66.2%) discharged whereas data for the remaining 93(19.1%) remain incomplete.29 Wang D and colleagues in a study of 143 patients observed that mortality was14 /143 (11.2 %) in moderate, 23/143 (33.3%) in severe and 68 (67.3% ) in critical cases.21
Carfi and colleagues in a study of 143 patients observed that only 13% patients were symptom free after mean 60 days of disease onset. The most common persistent symptoms were fatigue (53 percent), dyspnea (43 percent), joint pain (27 percent), and chest pain (22 percent); none had fever or features concerning for acute illness.37
Tenforde MW and collogues in a multistate telephonic survey of 292 patients having symptoms of cough, fever, breathlessness and fatigue at the time of testing revealed that 65% patients returned to the baseline health with a median of 7 days(5–12 days). Up to 43% of patients having cough,35% with fatigue and 29% having breathlessness at the time of testing continue to have these symptoms at the > two to three weeks after testing.18
A strong relationship was observed between the outcome of patient with age,, gram - Covid score risk category and number of comorbidities.
In our study relationship of age with outcome was strong as 6 deaths, 25 prolong stay and 49 recovered were observed in patients < 65 years of age whereas 51deaths,82 prolong stay and 22 recovery in age group > 65 years. AUCROC of age with outcome was 0.65(0.58–0.70) with sensitivity of 90% and specificity of 42%, negative predictive value of 98.7% and positive predictive value of 64% (p = 0.010).
In US epidemiologic study a high mortality ranging from 10%-27% was observed in the age group 85 and above,3%-11% in a age group 65–84 years, 1%-3% in a age group 55–64 years, and < 1% in people younger than 55 years.38
Harrison S and colleagues in a multicenter study comprising 31461 patients observed the risk of death in patients > 70 years was 1.3 times greater with heart failure, 1.9 times greater with renal disease compared to those without any these conditions. 39
In a cohort of 44000 confirmed cases of COVID-19 in China it was revealed that as the age increases the mortality increases with mortality > 80 years was 14.8%, 70–79 years 8%,60–69 3.6%, 50–59 1.3%, 40–49 years 0.4 % and those younger than 40 years 0.2%. 30
Regarding the gender there were 45 deaths ,84 prolong stay ,58.recovery in Male and 12 deaths, 23 prolong stay, 13.recovery in female group (p = 0.86). AUCROC of sex with outcome was 0.51(0.43–0.58) with sensitivity of 80% and specificity of 54% negative predictive value of 95% and positive predictive value of 54% (p = 0.79)
In contrast to our study Liu et.al comprising 1190 patients observed death in 157 patients. There were 100/157( 63.7%) male and 57/157(36.3%0 female showing high mortality in male comparing to female.40 According to a Chinese study the mortality of male were 2.8% versus 1.7% for female.41 The reasons for high mortality in our study might be due to high number of co-morbidities, more severe illness and more age among female patients.
In our study the severity of illness according to Covid Gram-score showed in Low- risk category 0 deaths,3 prolong stay and 15 recovery. Medium risk category 13 deaths,26prolong stay and 54 recovery and high risk group 44 deaths, 78 prolog stay and 2 recovery .AUCROC of severity of illness with outcome was 0.69(0.62–0.76) with sensitivity of 73% and specificity of 64% negative predictive value of 97.9% and positive predictive value of 96% (p = 0.010).
In a cohort by De Terwangne, C et.al patients were classified according to World Health Organization(WHO) severity classification into mild, moderate ,severe and critical. No patients in milder disease were admitted. Out of 295 patients 125 (42.4%) were in moderate ,69 (23.4%) in severe and 101(34.2%) were critical state. The mortality was14 (11.2 %) in moderate,23 (33.3%) in severe and 68 (67.3% )in critical cases. 35
Liang W et al in a cohort study of 1590 patients divided patients into low ,moderate and high risk based on Gram-Covid score. According to this study 1459 ( 91.7%) were in non-critical illness and 131(8.21%) were in critical illness group. An overall mortality of 50/1590(3.2%) was observed 17
In this study the number of comorbidities and outcome showed 7 patients died, 66 has prolong stay and 48 recovered in no co-morbidity, in one comorbidity group 14 deaths, 19 prolong stay and 16 recovered, in two comorbidities group 13 deayhs,14 prolong stay and, 5 recovery. with three comorbidities group 12 deaths,4 prolog stay and 2 recovery and in four comorbidities group 11 deaths,4 prolog stay and 0 recovery. AUCROC of number of Co-morbidities with outcome was 0.81(0.75–0.88) with sensitivity of 88% and specificity of 64% negative predictive value of 99% and positive predictive value of 88% (p = 0.010)
Peng YD et.al in a study of 112 patients dividing them into critical group (n = 16) and general group (n = 96) observed higher BMI 25.5 (CI 23.0, 27.5) in critical group vs general group. 22.0 (CI 20.0, 24.0), Furthermore on follow up 15/17 (88.4%) non-survivor had BMI > 25 kg/m2 compared to 18/95 (18.24%) survivors. 42
In a study by tartof et.al comprising 6916 patients noted a J shaped association between BMI risk of mortality. According to their observation patients with BMI > 45 kg/m2 had 4.18 times and BMI of 40 to 44 kg/m2 had 2.68 times higher risk of mortality compared to BMI of 18.5 to 24 kg/m2. This risk was more pronounced in the age group of 60 and below and male gender.43
Wang D in a cohort of 138 hospitalized patients observed any comorbidity in 72% patients who required intensive care unit (ICU) care (46% Non-ICU patients) with hypertension in 58% (31% in Non- ICU),CVD in 25% (15%Non-ICU), Diabetes in 22%(10% Non-ICU) patients. 22
Zhou F et.al in a cohort study comprising 191 patients comorbidities was revealed in 67% non-survivors (48% survivors) with hypertension in 48 (30%in survivors), Diabetes mellitus in 31% ( 19% survivors) ,CVD in 13% ( 8% survivors) patients. 28
Guan W-j et.al in a cohort of 1099 patients comprising outpatients and inpatients noted any comorbidity in 58% of non-survivors compared to 24% in survivor patients with hypertension in 36% in non-survivors (15% in survivors),Diabetes in 27% non-survivors (7.4% in survivors) and CVD in 9% non-survivors (2.5% survivors). 29