Effect of Systemic Illness and Comorbidities in the Prognosis of Severe Acute Respiratory Illness Patients: An Observational Study

Background: Globally critically ill COVID-19 (Coronavirus disease-19) patients have stretched critical care services. This study was undertaken to find factors implicated in mortality amongst COVID positive and negative patients presenting with severe acute respiratory illness (SARI) and factors having the probability of indicating COVID positivity. Methods: The demographic parameters, comorbid illness, clinical parameters and laboratory values of 327 patients were retrospectively analyzed to find the risk factors for mortality in COVID positive and negative patients and factors predicting COVID positivity amongst SARI patients. Results: 58% of SARI patients tested positive by RTPCR. Most common comorbidities were diabetes and hypertension, 35.2% and 33% respectively. Duration of swelling and low haemoglobin were significantly associated with mortality in COVID positive group (p=0.01, 0.005). Acidosis and tachycardia (p=0.003, 0.034) were associated with mortality amongst COVID negative. Creatinine, Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) were higher in non-survivors of both groups (p<0.001). Age, history of contact or from containment zone, cough, pain abdomen and P/F ratio were significant predictors of COVID positivity (1.020(1.006–1.035);3.889(1.316–11.495);2.908(1.182–7.152);2.147(1.149–4.012);0.997(0.994-1.000) respectively) by multivariable regression analysis. Conclusion: A long duration of swelling and low haemoglobin (<12 g%) were responsible for COVID positive mortality while pain abdomen, raised levels of AST, tachycardia and acidosis were associated with mortality in COVID negative. Deranged creatinine, higher SOFA and qSOFA were associated with mortality in both groups. Age, contact history, residence in containment zone, cough, pain abdomen and poor P/F ratio are predictive factors for COVID positivity. © 2023 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.

Outcome of COVID–19 associated severe ARDS: A case series

ICU course may be prolonged in patients suffering from Coronavirus associated acute respiratory distress syndrome (CARDS) due to severity of initial disease and presence of opportunistic infections. A structured approach to management may help reduce morbidity and mortality. Case presentation: We present a series of five cases of CARDS with a prolonged ICU course, despite the resolution of viremia. A multipronged therapeutic approach was adopted in the form of self proning, thrombo–prophylaxis, chest physiotherapy, adequate nutrition, psychotherapy and early mobilization. We could transfer two patients on domiciliary oxygen therapy and one on room air. Despite aggressive measures to control infection, one patient developed fungal sepsis, and another developed pseudomonal pneumonia. Both the patients rapidly deteriorated and succumbed to secondary infection, despite having shown initial recovery from CARDS. Conclusion: Prevention of infections is the key to recovery after resolution of viremia. This warrants COVID step down facility and structured rehabilitation program.