Outcome Prediction and Severity of Corona Virus Disease (COVID-19) on the Basis of Clinical and Laboratory Parameters

ABSTRACT

Background: Laboratory parameters play a key role in triaging, predicting disease course, severity and may determine prognosis COVID-19 patients. Material and methods: Aim and Objectives: To study the relation of clinical and laboratory parameters (total WBC count, neutrophil lymphocyte ratio, serum ferritin, serum D-dimer, serum LDH, CRP, ESR) with severity and outcome of Corona Virus Disease (COVID-19) confirmed by real-time RT-PCR. Sample size It was a time-bound study conducted over 3 months (1st April to 30th June, 2020). A total of 206 patients will be included in this study satisfying the inclusion criteria. Study design: This was a prospective, observational and non-interventional study conducted on patients with laboratory-confirmed COVID-19 admitted in a tertiary care teaching hospital. Statistical Analysis: Data will be analyzed for mean, percentage, standard deviation, and chi-square test for quantitative data by using appropriate statistical tests using INSTAT software version 8.0 (trial version) and p-value < 0.05 will be considered statistically significant. Results: Total of 206 patients of both genders were included in the present study. Total 141 (68.44%) patients were males and 65 (31.55%) patients were females (Chi Sq. 56.07;DF1;p < 0.001). Among all the groups according to the severity of illness, 'D' group was the most common group (n = 99;45.06%). Age > 60 years (17.48%), obesity (13.11%), hypertension (10.19%), COPD (5.83%), and diabetes mellitus (5.83%) were the most frequent risk factors or comorbidities associated with COVID-19 disease. Many patients had multiple risk factors in the present study. The majority (3/4th) of the patients were in C and D group (moderate) with co-morbidities and about 1/4th were in the severe group. Total 5 (2.43%) patients with COVID-19 patients succumbed to death with an overall case fatality rate of 2.43%. The case fatality rate was significantly higher among the patients with risk factors or comorbidities (p = 0.0124). Late presentation, associated comorbidity, advancing age, High level of ferritin, D-dimer, CRP, PaO2/FiO(2) ratio less than 100 at the time of admission were associated with mortality. The terminal event in patients who have succumbed was bradycardia followed by cardiorespiratory arrest. The cause of death was ARDS with bilateral extensive pneumonia. Conclusions: Late presentation, associated comorbidity like diabetes mellitus, advancing age, High level of ferritin, D-dimer, CRP, PaO2/FiO(2) ratio less than 100 at the time of admission were associated with mortality. The terminal event in patients who have succumbed was bradycardia followed by cardiorespiratory arrest. The cause of death was ARDS with bilateral extensive pneumonia.