Death profiling of hospitalized patients with COVID-19: Experience from a specialized hospital in Bangladesh (preprint)

Background: The information on characteristics and causes of mortality in deceased patients with coronavirus disease 2019 (COVID-19) is scarce in the literature. This study aimed to document the clinical profile with causes of death in deceased patients admitted in a COVID-19 dedicated hospital in Dhaka, Bangladesh. Methods: This cross-sectional retrospective study included 108 COVID-19 associated deceased patients admitted in Kurmitola general hospital, Dhaka, Bangladesh between 25 March 2020 and 24 June 2020) Data were collected from hospital record. Causes of death were categorized into early and late with cut-off of 48 hours of hospitalization. Results: Among 809 hospitalized cases of COVID-19, 108 patient died (13.35%) over three months of study period. The mean age of the deceased patients was 60.2 (SD 13.94) years; 86.1% were male. About 85% had at least one comorbidity with diabetes mellitus (65.7%) was the most common one. The most common symptoms were breathlessness (88.0%), fever (65.7%) and cough (43.5%). Nearly 75% presented with severe disease. Patients had altered biochemical profiles and treated with different drugs including antibiotics and steroids. Young age and malnutrition were two characteristic features. Only one third got intensive care support. The most common cause of death was acute respiratory syndrome (95.37%). Septic shock & acute myocardial infarction were predominantly early and uremia, hepatic failure & hyperglycemic crisis were the predominant causes of late hospital death. Conclusions: The findings of this study will help clinicians as well as policy makers to take necessary steps to prevent death from COVID-19 in Bangladeshi population.

Comparing between survived and deceased patients with Diabetes Mellitus and COVID-19 in Bangladesh: A cross- sectional study from COVID-19 dedicated hospital (preprint)

The current coronavirus disease 2019 (COVID-19) outbreak was reported to cause significantly higher mortality and morbidity among patients with diabetes mellitus (DM). Although Bangladesh is amongst the top 10 countries with diabetic people, data on these patients with COVID-19 is scarce from this region. This study aimed to illustrate the clinical features and outcomes of hospitalized patients with COVID-19 and DM in Bangladesh while comparing survivors and deceased. This retrospective cross-sectional study was conducted among RT-PCR confirmed COVID-19 patients with pre-existing Diabetes Mellitus in a specialized COVID-19 hospital in Bangladesh. Data from hospital records were analyzed. Among 921 RT-PCR confirmed COVID-19 admitted during the study period, 231 (~25%) patients with pre-existing DM (median age 60 years) were included in the analysis. The death rate among all hospitalized patients (with and without DM) was 2.8% compared to 11.3% among diabetic patients. The median hospital stay was 13 days (IQR 10.5, 17.0) for survivors and five days (IQR 2.0-8.3) for the deceased. The clinical features were not significantly different between survivors and the deceased. However, deceased patients had significantly lower blood oxygen level (85% vs 93%, p <0.001), and higher neutrophil-lymphocyte ratio (7.9 vs 4.5, p 0.003) and serum ferritin (946.0 vs 425.0 ng/ml, p 0.03). Glycemic status was poor in both groups. This study would help identify a subgroup of diabetic patients with COVID-19 who are at higher risk of in-hospital death and improve clinical decision making.

Clinical manifestations of patients with Coronavirus Disease 2019 (COVID- 19) attending at hospitals in Bangladesh (preprint)

Bangladesh is in the rising phase of the ongoing pandemic of the coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The scientific literature on clinical manifestations of COVID-19 patients from Bangladesh is scarce. This study aimed to report the sociodemographic and clinical characteristics of patients with COVID-19 in Bangladesh. We conducted a cross-sectional study at three dedicated COVID-19 hospitals. The severity of the COVID-19 cases was assessed based on the WHO interim guidance. Data were collected only from non-critical COVID-19 patients as critical patients required immediate intensive care admission making them unable to respond to the questions. A total of 103 RT-PCR confirmed non-critical COVID-19 patients were enrolled. Most of the patients (71.8%) were male. Mild, moderate and severe illness were assessed in 74.76%, 9.71% and 15.53% of patients respectively. Nearly 52.4% of patients had a co-morbidity, with hypertension being the most common (34%), followed by diabetes mellitus (21.4%) and ischemic heart disease (9.7%). Fever (78.6%), weakness (68%) and cough (44.7%) were the most common clinical manifestations. Other common symptoms included loss of appetite (37.9%), difficulty in breathing (37.9%), altered sensation of taste or smell (35.0%), headache (32%) and body ache (32%). The median time from onset of symptom to attending hospitals was 7 days (IQR 4-10). This study will help both the clinicians and epidemiologists to understand the magnitude and clinical spectrum of COVID-19 patients in Bangladesh.