Neurological Manifestations and Their Effect on Outcome in Second Wave of COVID-19 Pandemic: A Retrospective Cohort Study

Aim: There is a need for a better understanding of the relation of various neurological symptoms and complications with manifestations and outcomes of coronavirus disease 2019 (COVID-19). Hence, we planned this study to get an insight into the relation of neurological manifestations and COVID-19. Materials and methods: This was a retrospective study. All patients ?18 years in age, admitted with reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19 were included in the study. Their clinical records were accessed for collecting demographic and laboratory data. The data collected were analyzed for prevalence and pattern of neurological symptoms at admission and neurological complications developed during hospitalization. It was also analyzed to find the relation of neurological manifestations with duration of hospital stay, requirement of bilevel positive airway pressure (BiPAP) or ventilator, severity of disease, development of neurological complications, and mortality. Results: A total of 440 patients were included. The mean age was 59.28 ± 13.28 years. The most common neurological symptom at presentation was headache while the most common neurological complications were altered sensorium, cerebrovascular stroke, seizure, and encephalitis. Significantly, more patients with neurological complications than those without had severe disease and needed ventilation. Duration of hospitalization was significantly longer (16.26 ± 5.15 vs 12.73 ± 4.89, p = 0.0173) and mortality was also significantly higher (OR 6.59, 95% CI 2.23–19.43; p = 0.0006) in patients with neurological manifestations. Conclusion: The presence of neurological manifestations is associated with greater morbidity and mortality in patients with COVID-19 and thus warrants more aggressive treatment. However, a study of association of individual neurological manifestation with severity of COVID-19 will provide a more meaningful insight regarding the approach to the management of such patients

Type 2 DM An Independent Risk Factor For Poor Outcome In Moderate To Severe COVID-19

Background:Diabetes Mellitus has been shown to be a risk factor for severe COVID-19 disease. Few studies asse ssed effect of diabetes on the outcome exclusively in moderate to severe COVID 19 disease. Objective: To compare the clinical characteristics and outcome of hospitalized moderate and severe COVID-19 disease among patients with and without diabetes. Material And Methods:This retrospective study was conducted at Parul Sevashram Hospital from 1stApril 2021-30thApril 2021. Data on demographic profile, clinical symptoms, laboratory findings, complications and clinical outcome was collected and compared between patients with and without diabetes.Result:Total 319 patients were included with mean age 54.81±11.72 years. 28.5% had diabetes. The most common symptoms were fever, cough and shortness of breath. As compared to patients without diabetes, these patients had significantly higher levels of leucocyte count, CRP, Ferritin, LDH and D-Dimer. They also had more complications like ARDS, secondary infection and stroke and higher need of respiratory support (92.3% vs. 69.7%, P < 0.001). We also observed significantly greater mortality in patients with diabetes compared to those without diabetes (29.7% vs. 13.6%; P = 0.0014). These findings held true even on comparingpatients with only diabetes as comorbidity to those without any comorbidity.Conclusion:The study confirms that diabetes is an independent risk factor for higher inflammatory markers, risk of complications and in hospital mortality during hospitalization with moderate to severe COVID 19. New strategies are needed for more aggressive management of COVID 19 cases with diabetes to improve prognosis in these cases.

Identifying Risk Factors For ICU Admission During The Second Wave Of COVID 19 In A Tertiary Care Centre In Western India

Background:The substantial morbidity and mortality seen during second wave of coronavirus disease 2019 (COVID-19) pandemic necessitated identifying demographic, clinical and laboratory markers to assist the clinicians in early recognition of severe disease. We aimed to identify new factors or confirm previously identified factors for risk of ICU (Intensive care unit) admission during the second wave of COVID-19 infection. Material And Methods:This retrospective, single-centre study was conducted from April 1 2021-May30 2021. Data on demographic profile, clinical symptoms, and laboratory findings on admission was collected and compared between ICU and non-ICU patients. Result:Total 440 patients were included. Among these, 184(41.8%) needed ICU admission. The mean agewas 52.75±14.46years. 283(64.3%) patients were males. The most common symptoms were fever (70.7%), cough (65.5%), and shortness of breath (54.1%). As seen in previous studies, mean age, leucocyte count, CRP, S. ferritin, LDH, D-Dimer and comorbidities like diabetes mellitus, COPD, obesity were found more commonly in ICU patients as compared to non-ICU patients. (P= 0.0107, 0.0447 and 0.0314 respectively for diabetes, COPD and obesity). Presence of more than one comorbidity was associated with greater ICU admission (ICU vs. Non-ICU: 92(50%) vs. 99 (38.7%), p=0.0234).Time from symptom onset to hospitalization was also significantly longer in ICU patients (7.5±1.05 days vs 4.0±1.26 days; p=0.004). Conclusion:The study confirms that COVID patients who need ICU admission have significantly higher mean age, leucocyte count, CRP, S. ferritin, LDH, D-Dimer and comorbidity. In addition, COVID patients in ICU had significantly lower s. albumin levels and late presentation to hospital.