An Analytical Study of Disease Parameters in COVID-19 Deaths Treated in aTertiary Care Centre in Bangalore

Introduction

The entire world was taken by a huge shock by COVID-19 pandemic1 which arrived in India around March 2020 and overwhelmed the health system all over India including Karnataka. This compelled the Government to mandate all medical colleges to treat COVID-19 patients. Our hospital took up the same from June 30, 2020 till date. Here is our effort to analyze the pattern of mortality and severity among COVID-19 deceased during the period June 30 to November 30, 2020 (5 months) in relation to sex and various aspects of severity of disease like symptoms, signs, duration of stay in hospital and such other parameters.

Materials and Methods

This was a retrospective study involving all the cases of COVID-19 deceased who were admitted and treated in the hospital between 30th June 2020 to 30th November 2020.

Results

A total of 2800 patients were treated, and mortality was around 57 (around 2%). With respect to age distribution, mortality was more in the age group of 45 to 64 years (33.33%) followed by age group of 65 to 74 years (24.56%).

With respect to sex distribution, mortality was more in males (75.4%) than females (24.6%) (Chi square 14.75, p <.000) which was similar to the trend all over the world.

With respect to co-morbid conditions, 50.9% patients had co-morbid conditions like diabetes mellitus, hypertension, chronic renal failure and others, while 49.1% of the patients did not have any co-morbid conditions.

Initially due to non-availability of Remdesivir and later due to non-affordability despite the availability of Remdesivir, 73.7% of the patients were not administered, while 26.3% were administered. Mortality was more among those who were not administered Remdesivir (Chi square 10.965, p <.00).

Maximum patients presented with fever (84.2%, Chi square 26.68, p <.000) and breathlessness (82.5%, Chi square 24.02, p <.000) followed by cough (71.9%, chi square 10.965, p <.00) and other symptoms (26.3%, Chi square 12.79, p <.000) like diarrhea.

Examination and laboratory findings revealed tachypnea in maximum patients (66.7%, Chi square 6.33, p <.05) followed by abnormal lung auscultation findings in 26.3% patients (Chi square 12.79, p <.000) and abnormal lung skiagram findings in 24.6% patients (Chi square 14.75, p <.000).

Discussion

Chen L et al² reported similar findings in 68 deceased patients in Hubei province in China with respect to comorbidities noted in around 50% of the patients. With respect to gender distribution, they reported equal distribution among men and women (50%), while our study showed higher predominance in men (75.4%).

With respect to initial symptoms, Chen L et al² reported similar findings as our study with fever in 59 patients (87%), cough in 52 patients (76%) but lower proportion had shortness of breath 6 (9%) compared to their study (In our study, 82% i.e, 47 patients presented with shortness of breath).

Time from onset of illness to admission in hospital was almost same in their study² as our study (Chen L² 4 Vs our study 4.56).

Richardson S et al ³ found the length of hospital stay among who died was 5 to 6 days in the age group of 40 to 70 years which was similar to our study at 6 to 7 days.

Jin JM et al ⁴ reported the mean age of the deceased (n=37) as 70 years, while in our study it was much lower at 58.56 years. Their study was similar in respect to higher mortality rate in men (70.3%) than women as in our study. Fever was found in 32 patients (86.5%) which was similar to our study and cough in 25 patients (67%) which was lower compared to our study. Co-morbidities were present in 48.6% of patients similar to our study.

Chidambaram V et al⁵ used risk ratios to deduce that male sex had greater susceptibility to COVID-19 than female sex. Patients with diabetes and hypertension had higher susceptibility to COVID-19 than those without them. Fever, cough and dyspnea were also higher among COVID-19 patients.

When we compared the systematic review of Chidambaram V et al⁵ with relative risks (RR) of various factors for mortality in our study, relative risk for males (RR 3.07), cases with fever (RR 5.33), breathlessness (RR 4.27) and cough (RR 2.56) was very high compared to the systematic review (Systematic review5 males RR 1.45, Fever RR 0.82, Cough RR 1.0, Breathlessness/ Dyspnoea RR 2.55).

Relative risk of Diabetes (RR 0.72), Hypertension (RR 0.29) cases was low compared to systematic review. (Systematic review Diabetes RR 1.59, Hypertension RR 1.90)

Conclusion

Overall males showed higher mortality rate and severity of disease parameters than females. Statistics were significant for mortality being more among males (p <.000) and mortality being more among those not administered with Remdesivir (p <.00). The presence of symptoms such as fever, cough and breathlessness were found in majority of COVID-19 deceased patients (p <.000). Even the findings tachypnea, abnormal X-ray findings and abnormal lung auscultation were found in majority of COVID-19 deceased patients (p <.05). Relative risk of mortality was more for males and those with fever, cough, and breathlessness symptoms.

Findings of our study were similar to some studies conducted in other parts of the world with minor differences in proportion of different presenting symptoms and signs. COVID-19 appears to have similar type of severity and mortality pattern all over the world.

Conflict of Interest

None.