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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 11
| Issue : 3 | Page : 185-189 |
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Clinical profile of COVID-19 patients and association between morbidities and mortality due to COVID-19 at a tertiary care center
Manjusha Ashwinkumar Dhoble1, Priya Prabhakar Dhurve2, Hema Murari3, Rupali Amarkantak Patle3
1 Department of Community Medicine, Government Medical College, Nagpur, Maharashtra, India
2 Department of Community Medicine, Government Medical College, Chandrapur, Maharashtra, India
3 Department of Community Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| Date of Submission | 25-Jul-2022 |
| Date of Decision | 15-Dec-2022 |
| Date of Acceptance | 17-Dec-2022 |
| Date of Web Publication | 05-Jul-2023 |
Correspondence Address:
Priya Prabhakar Dhurve
Department of Community Medicine, Government Medical College, Ramnagar, Chandrapur - 442 401, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/mjhs.mjhs_62_22
Background: The globe has faced a number of challenges in recent years from viral epidemics brought on by newly developing zoonotic diseases, particularly the coronavirus family of viruses. Patients with COVID-19 disease are more likely to experience a more severe course and progression of the disease if they also have comorbid conditions such as hypertension or diabetes mellitus. Hence, the present study was carried out to study the clinical characteristics of COVID-19 patients and the association between COVID-19-related morbidities and mortality in a tertiary care center.
Objectives: The objective of this study was to study the clinical profile of COVID-19 patients and the relationship between COVID-19-related morbidities and death at a tertiary care facility.
Methodology: The present study was a cross-sectional study which was carried out in the tertiary care hospital of Central India from March 2020 to August 2021 on 11,201 patients.
Results: Among the 11,201 study subjects, 6755 (60.31%) were males and 4446 (39.69%) were females. The majority of the study subjects, 2428 (21.68%), were between the age group of 51–60 years. Cough was the major presenting complaint found in 5243 (46.81%) study subjects. Hypertension was the main morbid condition in 2249 (20.08%) study subjects. Among the 11,201 admitted patients, 8763 (78.23%) were discharged, and in 2438 (21.77%) study subjects, the outcome was death.
Conclusions: Since morbid conditions such as diabetes and hypertension were more prevalent and it affects more in COVID-19 disease mortality.
Keywords: Comorbidity, COVID-19, mortality, outbreak, pandemic, quarantine, zoonotic diseases
How to cite this article:
Dhoble MA, Dhurve PP, Murari H, Patle RA. Clinical profile of COVID-19 patients and association between morbidities and mortality due to COVID-19 at a tertiary care center. MRIMS J Health Sci 2023;11:185-9 |
How to cite this URL:
Dhoble MA, Dhurve PP, Murari H, Patle RA. Clinical profile of COVID-19 patients and association between morbidities and mortality due to COVID-19 at a tertiary care center. MRIMS J Health Sci [serial online] 2023 [cited 2023 Oct 2];11:185-9. Available from: http://www.mrimsjournal.com/text.asp?2023/11/3/185/380486 |
| Introduction | |  |
Globally, as on August 11, 2022, there were 585,086,861 confirmed cases of COVID-19 and 6,422,914 deaths reported to WHO. In India, from January 3, 2020, to August 11, 2022, there were 44,206,996 confirmed cases of COVID-19 with 526,879 deaths, reported to WHO.[1]
COVID-19 has an incubation period of an average of 5–6 days, which can extend up to 14 days, with the potential asymptomatic transmission. Patients with SARS-CoV-2 infection may have asymptomatic mild illness.[2] The symptoms of COVID-19 include aches, nasal congestion, runny nose, sore throat, myalgia, generalized weakness, breathlessness, conjunctivitis, diarrhea, lower respiratory tract infection, mild-to-severe pneumonia, dry cough, fever, and exhaustion.[2],[3],[4],[5] Patients with moderate infections typically exhibit symptoms including dry cough, nausea, vomiting, diarrhea, lethargy, and fever, whereas those with severe infections may experience hypoxemia, septic shock, acute respiratory distress syndrome (ARDS), metabolic disorders, and, in extreme circumstances, and even death.[2],[6],[7],[8]
In addition to the pandemic situation brought on by the coronavirus, it has been discovered that the affected people also suffer from severe comorbid conditions, such as hypertension and diabetes, have shown worse prognosis. Diabetic patients have increased morbidity and mortality rates and have been linked to more hospitalization and intensive care unit (ICU) admissions.[9],[10] COVID-19 has demonstrated a wide spectrum of clinical manifestations, from asymptomatic or paucisymptomatic forms, to severe viral pneumonia with respiratory failure, multiorgan and systemic dysfunctions in terms of sepsis and septic shock, and death.[11],[12] Previous studies have demonstrated that the presence of any comorbidity has been associated with a 3.4-fold increased risk of developing acute respiratory distress syndrome in patients with H7N9 infection.[11]
There are many studies which shows association between various factors and mortality. The association of sex, age, chronic obstructive lung disease, diabetes, hypertension, and other comorbidities on the risk of death due to COVID-19. Patients with COVID-19 disease are more likely to experience a more severe course and progression of the disease if they also have comorbid conditions like hypertension or diabetes mellitus. Additionally, older patients, particularly those who are infected, over 65, and have coexisting conditions, had a greater likelihood of ICU admission and COVID-19 disease death. Obesity, hypertension, and diabetes mellitus were the most prevalent co -morbidities identified. In a tertiary care setting, the aim of this study is to evaluate the clinical features of COVID-19 patients and the association between COVID-19 disease with co- morbidities and mortality.
| Methodology | | |
The present study was a cross-sectional study which was carried out in a tertiary care hospital of Central India. The first case of COVID-19 was reported on March 11, 2020, in the study hospital. As cases were increasing in trend, this hospital was declared as dedicated COVID-19 hospital. The study was carried out from March 2020 to August 2021 on 11,201 patients. All hospitalized and brought dead patients who tested positive on a rapid antigen test or real-time reverse transcriptase–polymerase chain reaction were included in the study. Patients whose reports were unclear were not included in the investigation.
Among the admitted patients, the outcome is either discharged or death. Data were collected regarding age, sex, symptoms, morbidities, and treatment outcome of patients as cured and died. The clinical data includes symptoms at the time of admission and comorbidities. The correlation between a few factors (including age, gender, and morbidity) and treatment outcome was studied.
Ethical considerations
Before starting a study, permission from the college's institutional ethics committee was obtained. No requirement for informed consent existed.
Statistical analysis
The frequency and percentages for the categorical variables as well as the mean, standard deviation, and median for the continuous variables were used to summarize the data. The Chi-square test was applied to study the association.
| Results | | |
Of the 11,201 participants in the study, 6755 (60.31%) were men and 4446 (39.59%) were women. The majority of the study participants, 2428 (21.68%), were between the ages of 51 and 60 [Table 1].
Death was the outcome for 2438 (21.77%) study participants (includes death after admission and brought dead patients). The majority of study participants, 8763 (78.23%), were discharged and 2438 (21.77%) died [Table 2].
Cough was the most frequent presenting symptom reported by study participants (5243, 46.81%), followed by dyspnea (4681, 41.79%). Of the study's participants, 1477 (13.19%) were symptom-free [Table 3].
The majority of study participants, 2249 (20.08%), had hypertension whereas 1766 (15.77%) had diabetes [Table 4].
Age, gender, and morbidity were found to be statistically significantly correlated with outcome, with P values of 0.011, 0.003, and 0.0001, respectively [Table 5].
| Discussion | | |
The study discovered a 1.52:1 male-to-female case ratio.
On the other hand, Ranjan et al.,[13] discovered that the male-to-female ratio of cases was 2.88:1.
According to the current study, out of 11,201 patients, 6755 (60.3%) were men, and 2428 (21.68%) of the patients were between the ages of 51 and 60.
These results are close to those of a study by Patel et al.,[14] which revealed that 60.29% of the population was male and that the majority of patients (21.07%) were between the ages of 51 and 60.
According to Papageorge et al.,[15] study, 44% of respondents are men, and roughly 39% are 56 or older.
Another study by Iftimie et al.,[16] Peres et al.,[17] and Guan et al.,[11] found that 57%, 54.9% and 57.3% were male patients respectively
The study found that cough was the most common symptom, 5243 (46.81%), followed by breathlessness in 4681 (41.79%) study subjects. Patel et al.[14] found that the most common symptom was fever of 185 (44.79%) and cough of 146 (35.35%), followed by breathlessness of 134 (32.45%).
While breathlessness was the primary presenting symptom, followed by fever and cough, according to research by Tambe et al.,[18] more than one-fifth of individuals admitted due to exposure had no symptoms at the time of admission. On the other hand, a study by Mario et al.[19] found that the most common clinical features upon admission were low-grade fever, dry cough, general malaise, and dyspnea.
A study carried out by Guan et al.,[11] found that the most common symptom was fever (88%) and dry cough (70.2%). Similar study findings were reported from the study by Iftimie et al.,[16] where the most common symptoms were fever 134 (65.6%), dyspnea 122 (59.8%), and pneumonia 119 (58.3 5).
The study found that 4471 (39.91%) patients were having comorbidities. The most common comorbidity found was hypertension which was present among 2249 (20.08%) patients. On the contrary study by Patel et al.[14] found that the most common comorbidity was diabetes mellitus which was present in 24.69% of patients. These results were almost identical to those of a research by Patle et al.[2] Who Discovered that type 2 diabetes mellitus and hypertension were the most common morbidities among 557 patients, or 46.80% and 30.00%, respectively.
According to another study, diabetes (8.2%) and hypertension (16.9%) were the two most common comorbidities
A Study done by Peeri et al.,[20] showed that underlying comorbidities were reported amongst [13 (32%)] which included diabetes, hypertension and cardiovascular disease. According to a study by Tambe et al.,[18] of the 93 COVID-19 cases with documented comorbidity. A similar study was carried out by Peres et al.,[17] where they reported comorbidities amongst 61,309 (27%) COVID patients.
The study found that men, 1533(22.68%) are at higher risk of dying from COVID than women 905(20.38%).
The months of August and September had the highest patient admissions in our analysis.
The study done by Karmakar et al.[21] showed that most sociodemographic factors were significantly associated with both incidence and mortality.
Age, gender, and morbidity were found to have a statistically significant relationship to treatment outcomes in our study. Many of the worse outcomes for COVID-19 have been linked to cardiovascular comorbid diseases, according to a study by Guan et al.[11] In addition, Wang et al.[22] study's revealed that patients with type 2 diabetes were more likely to experience COVID-19 with increasing severity.
The study was carried out in Central India, which may limit the generalizability of the findings. Diabetes and hypertension are more prevalent in India and our study was planned to assess its association with COVID-19 mortality which was statistically significant.
| Conclusions and Recommendations | | |
Since morbid conditions such as diabetes and hypertension are more prevalent and affect more in COVID-19 patients, strategies such as lifestyle modification and mass vaccination should be implemented strictly through national policies. The government should consider the pandemic as an emergency and be prepared with policies to handle such situations in the future.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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