Predictors of mortality among COVID-19 patients admitted in a dedicated COVID hospital during the pandemic in Himachal Pradesh, India

Authors

  • Anita Thakur Department of Community Medicine, Shri Lal Bahadur Shastri Government Medical College, Himachal Pradesh, India
  • Durgesh K. Thakur Department of Community Medicine, Shri Lal Bahadur Shastri Government Medical College, Himachal Pradesh, India
  • Chitvan Thakur Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20222383

Keywords:

COVID-19 mortality, Comorbidities, Pandemic, Predictors, Delayed hospitalization

Abstract

Background: The outcome of COVID-19 disease is variable. Mostly patients have mild to moderate disease and get recovered; some patients have severe disease leading to mortality. Hence it is essential to find out the factors affecting the outcome in the COVID-19 patients. The aim of this study was to identify predictors of mortality among hospitalized patients of COVID-19 and to estimate their prevalence among these patients.

Methods: This was an observational study, longitudinal in design, carried out among 790 COVID-19 patients hospitalized in a tertiary care dedicated COVID hospital in Himachal, during the second wave of COVID.

Results: Overall 26.2% of the hospitalized patients were having one or more co morbidities. DM (17.6%) and delayed hospitalization (42.7%) were highly prevalent risk factors among hospitalized patients with high mortality 39.6% and 49% respectively. Overall mortality rate among study participants was 29.7%. Patients having malignancy and other immuno-compromising diseases had highest mortality rate 68.4%. Median time gap between onset of symptoms and hospitalization was 9 days among those who died and 5 days among those who recovered. On multivariate logistic regression analysis higher age (>60 years) AOR 5.392 (3.435-8.463), delayed hospital admission AOR 8.204 (5.522-12.188), diabetes mellitus AOR 1.888 (CI-1.199-2.972), malignancy and other immune compromising diseases AOR 9.108 (2.934-28.270) and chronic kidney disease AOR 7.524 (CI=2.289-27.735) were the significant predictors of mortality.

Conclusions: We observed the higher COVID-19 mortality among the patients having higher age, DM, CKD, immunocompromising diseases and delay in hospitalization. DM and delayed hospitalization were two most prevalent risk factors present among these patients.

Author Biographies

Anita Thakur, Department of Community Medicine, Shri Lal Bahadur Shastri Government Medical College, Himachal Pradesh, India

Assistant professor @ Deptt.of community medicine

Durgesh K. Thakur, Department of Community Medicine, Shri Lal Bahadur Shastri Government Medical College, Himachal Pradesh, India

Department of Community Medicine, Shri Lal Bahadur Shastri Government Medical College, Mandi at Ner Chowk (HP)

Chitvan Thakur, Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Deptt Of Community Medicine,IGMC Shimla

References

Andrews MA, Areekal B, Rajesh KR, Krishnan J, Suryakala R, Krishnan B, et al. First confirmed case of COVID-19 infection in India: A case report. Indian J Med Res. 2020;151:490.

Ministry of Health and Family Welfare Government of India. Available at: https://www.mohfw.gov.in/. Accessed on 30 May 2021.

Mohan A, Tiwari P, Bhatnagar S, Patel A, Maurya A, Dar L, et al. Clinico-demographic profile & hospital outcomes of COVID-19 patients admitted at a tertiary care centre in north India. Indian J Med Res. 2020;152:61.

Clark A, Jit M, Warren-Gash C, Guthrie B, Wang HH, Mercer SW, et al. Centre for the Mathematical Modelling of Infectious Diseases COVID-19 working group. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. Lancet Glob Health. 2020;8:e1003-17.

Alaa A, Qian Z, Rashbass J, Benger J, van der Schaar M. Retrospective cohort study of admission timing and mortality following COVID-19 infection in England. BMJ Open. 2020;10:e042712.

Agarwal N, Biswas B, Lohani P. Epidemiological determinants of COVID-19 infection and mortality: A study among patients presenting with severe acute respiratory illness during the pandemic in Bihar, India. Niger Postgrad Med J. 2020;27:293.

Gandhi PA, Kathirvel S. Epidemiological studies on coronavirus disease 2019 pandemic in India: Too little and too late? Med J Armed Forces India. 2020;76:364.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395:1054-62.

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323:1574-81.

Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020;323:1775-6.

Sohrabi C, Alsafi Z, O'neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71-6.

Opal SM, Girard TD, Ely EW. The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis. 2005;41:S504-12.

Olivas-Martínez A, Cárdenas-Fragoso JL, Jiménez JV, Lozano-Cruz OA, Ortiz-Brizuela E, Tovar-Méndez VH,et al. In-hospital mortality from severe COVID-19 in a tertiary care center in Mexico City; causes of death, risk factors and the impact of hospital saturation. Plos One. 2021;16:e0245772.

Bello-Chavolla OY, Bahena-López JP, Antonio-Villa NE, Vargas-Vázquez A, González-Díaz A, Márquez-Salinas A, et al. Predicting mortality due to SARS-CoV-2: a mechanistic score relating obesity and diabetes to COVID-19 outcomes in Mexico. J Clin Endocrinol Metab. 2020;105(8):2752-61.

Akhtar H, Khalid S, Rahman FU, et al. Delayed admissions and efficacy of steroid use in patients with critical and severe COVID-19: an apprehensive approach. J Public Health (Oxf). 2021;fdab239.

Alaa A, Qian Z, Rashbass J, Benger J, van der Schaar M. Retrospective cohort study of admission timing and mortality following COVID-19 infection in England. BMJ Open. 2020;10:e042712.

Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020;180:1345-55.

Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ ; HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 202;395(10229):1033-4.

Muniyappa R, Gubbi S. COVID-19 pandemic, coronaviruses, and diabetes mellitus. Am J Physiol Endo-crinol Metab. 2020;318:E736-41.

Hodgson K, Morris J, Bridson T, Govan B, Rush C, Ketheesan N. Immunological mechanisms contributing to the double burden of diabetes and intracellular bacterial infections. Immunology. 2015;144:171-85.

Pandita A, Gillani FS, Shi Y, Hardesty A, McCarthy M, Aridi J, Farmakiotis D, Chiang SS, Beckwith CG. Predictors of severity and mortality among patients hospitalized with COVID-19 in Rhode Island. Plos One. 2021;16:e0252411.

Ahmad S, Kumar P, Shekhar S, Saha R, Ranjan A, Pandey S. Epidemiological, Clinical, and Laboratory Predictors of In-Hospital Mortality Among COVID-19 Patients Admitted in a Tertiary COVID Dedicated Hospital, Northern India: A Retrospective Observational Study. J Prim Care Community Health. 2021;12:21501327211041486.

Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97:829-38.

Ji D, Zhang D, Xu J, Chen Z, Yang T, Zhao P, Chen G, Cheng G, Wang Y, Bi J, Tan L. Prediction for progression risk in patients with COVID-19 pneumonia: the CALL score. Clin Infect Dis. 2020;71:1393-9.

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Published

2022-09-28

How to Cite

Thakur, A., Thakur, D. K., & Thakur, C. (2022). Predictors of mortality among COVID-19 patients admitted in a dedicated COVID hospital during the pandemic in Himachal Pradesh, India. International Journal Of Community Medicine And Public Health, 9(10), 3666–3672. https://doi.org/10.18203/2394-6040.ijcmph20222383

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Original Research Articles