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Study of factors associated with critical illness in Corona virus disease-19 patients admitted at a tertiary care hospital

Binti Sumanbhai Patel, Harsha Makwana, Sanjay Solanki, Vidhi Shah, Advait Thakor.

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Background: China announced Covid-19 in December 2019, since then it has become pandemic and many cases have been reported in India. India has highest number of cases in Asia after united states and brazil till July 2020. Very little is known about factors associated with critical illness in Covid-19 patients. Early recognition and intervention in such cases will prevent further deterioration by effective allocation of health care resources and decreases morbidity and mortality so, we decided to study on this.
Aims and objectives: To study Corona virus disease-19 patients for the factors associated with critical illness and their outcome.
Material and method: It is a retrospective study, Corona virus disease-19 positive and critical patients admitted to our Intensive care unit and aged more than 18 years during the period of 1st April 2020 to 30th June 2020 were included in our study. Age less than 18 years, hospitalized corona virus disease-19 negative cases, pregnant females and stable patients were excluded.
Testing was performed for patients presenting to our tertiary care hospital, with any complaint consistent with Corona virus disease-19, including fever, runny nose, cough, shortness of breath, fatigue, gastrointestinal complaints, syncope, loss of smell or taste, generalized weakness, headache.
A positive case of Corona virus disease-19 was confirmed by real-time reverse transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasopharyngeal or oropharyngeal swab specimens.
From the electronic health record, We obtained the following data: age, gender, addiction(smoking, tobacco, alcohol), history of contact with positive cases, history of travel, health care worker, symptoms, oxygen saturation(SpO2 on room air), co-morbidities- Hypertension, Diabetes mellitus, Ischemic heart disease (IHD), Cerebrovascular accident (CVA), chronic kidney disease, any past pulmonary disease (chronic obstructive pulmonary disease or asthma, past history of pulmonary tuberculosis, Allergic bronchitis), liver disease, immunocompromised state, obesity and others (rheumatoid arthritis, myasthenia gravis, interstitial lung disease, psychiatric illness), inflammatory markers (C-reactive protein, Lactate dehydrogenase, D-dimer, ferritin), X ray chest, oxygen therapy and mechanical ventilation and outcome of patients.
Data from hospital information system was collected in a case record form, entered in Microsoft excel sheet (version 16) and analyzed with Statistical package for the social sciences software.
The data of 356 patients was collected for this study, Corona virus disease-19 was found more common in males and common age group is 59-78 years. Hypertension was the most commonly found co-morbidity followed by diabetes mellitus. Total 206 patients required mechanical ventilation, out of which 159 patients required invasive mechanical ventilation. Acute respiratory distress syndrome (ARDS) was the most common complication among expired patients responsible for mortality. More than 72.75% patients had raised inflammatory markers. Out of 356 patients 41.85% were expired, 55.06% discharged and 3.09% took Leave against medical advice.

We concluded that age more than 58 years, associated co morbidities, raised inflammatory markers and decreased oxygen saturation are the significant factors associated with critical illness in Corona virus disease-19 patients. Early recognition and intervention in such cases will prevent further deterioration and save a person’s life.

Key words: Critical illness, Co-morbidities, Mechanical ventilation, Acute respiratory distress syndrome, Inflammatory markers

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