Predictors of mortality in COVID-19 disease

ABSTRACT

Background: COVID-19, an acute viral respiratory illness, was first noted in 2019, soon turned into pandemic with considerable mortality. With the objective of studying effect of comorbidities on COVID-19 disease severity and to identify laboratory markers associated with severe COVID-19 disease, we did a retrospective observational study in a tertiary care centre. Aims and Objectives: The objectives of this study were as follows 1. To study effect of comorbidity on COVID-19 disease severity and 2. to identify laboratory markers associated with severe COVID-19 infection and mortality. Materials and Methods: This is an retrospective observational study conducted at SDMCMS&H, Dharwad from July 2020 to September 2020. A total of 402 cases who fall in the age group of 18 years and above were collected from medical record department. Statistical analysis used The data were recorded in the Microsoft Excel sheet and analysis is done using Chi-square analysis and Cox linear regression method. Results: There were 402 patients whose data were collected. Out of 402 patients, 64 patients (15.92%) were in the age group of 18-39 years, 183 patients (45.52%) seen were in the age group of 40-60 years, 155 patients (38.56%) above 60 years, and consisting 291 male patients (72.39%) and 111 female patients (27.9%). Most common comorbidities seen were diabetes mellitus in 194 patients (48.26%) and hypertension in 182 patients (45.27%), followed by chronic kidney disease in 32 patients (7.96%) and ischemic heart disease in 24 patients (5.97%). Out 402 patients, 141 patients (35.07%) were on supplemental oxygen, which included 68 patients (48.23%) on low flow oxygen by face mask, seven patients (4.96%) were on non-rebreathing mask, 3 (2.13%) patients required NIV, and 63 patients (44.68%) required intubation and mechanical ventilation. It was found that uncontrolled diabetes rather than just presence of diabetes had significant impact on mortality with P=-0.0001 (95% CI OR 1.5-4.38). Patients with increased laboratory markers of inflammation such as Ferritin (95% CI OR 1.84-6.81) and LDH (95% CI OR 1.86-31.26) had strong association with mortality. The presence of thrombocytopenia showed significant association with mortality (95% CI OR 1.03-3.63). Conclusion: The presence of preceding uncontrolled hyperglycemia has significant effect on mortality. A state of hyperinflammation is directly associated with poor outcome.