key: cord-1004969-wbcrbp58
authors: Imran, M.; Uddin, A.; Yousaf, M.; Khan, S.; Khan, A. J.; Iqbal, Z.; Jan, R.; Khan, M. S.
title: COVID-19 outcomes associated with clinical and demographic characteristics in patients hospitalized with severe and critical disease in Peshawar
date: 2022-03-25
journal: nan
DOI: 10.1101/2022.03.24.22272884
sha: 4dd3e97f0cf8144a6a2314de1797975a196b5830
doc_id: 1004969
cord_uid: wbcrbp58

Background As a novel disease, understanding the relationship between the clinical and demographic characteristics of coronavirus disease 2019 (COVID-19) patients and their outcome is critical. We investigated this relationship in hospitalized patients in a tertiary healthcare setting. Aims/objectives To study COVID-19 severity and outcomes in relation to clinical and demographic characteristics of in admitted patients Methodology In this cross-sectional study, medical records for 1087 COVID-19 patients were reviewed to extract symptoms, comorbidities, demographic characteristics, and outcomes data. Statistical analyses included the post-stratification chi-square test, independent sample t-test, multivariate logistic regression, and time-to-event analysis. Results The majority of the study participants were >50 years old (67%) and male (59%) and had the following symptoms: fever (96%), cough (95%), shortness of breath (73%), loss of taste (77%), and loss of smell (77%). Regarding worst outcome, multivariate regression analysis showed that these characteristics were statistically significant: shortness of breath (adjusted odds ratio [aOR] 31.3; 95% CI, 11.87-82.53; p < 0.001), intensive care unit (ICU) admission (aOR 28.3; 95% CI,9.0-89.6; p < 0.001), diabetes mellitus (aOR 5.1; 95% CI;3.2-8.2; p < 0.001), ischemic heart disease (aOR 3.4; 95% CI,1.6-7; p = 0.001), nausea and vomiting (aOR 3.3; 95% CI, 1.7-6.6; p = 0.001), and prolonged hospital stay (aOR 1.04; 95% CI, 1.02-1.08; p = 0.001), while patients with rhinorrhea were significantly protected (aOR 0.3; 95% CI, 0.2-0.5; p < 0.001). A Kaplan-Meier curve showed that the symptoms of shortness of breath, ICU admission, fever, nausea and vomiting, and diarrhea increased the risk of mortality. Conclusion Increasing age, certain comorbidities and symptoms, and direct admission to the ICU increased the risk of worse outcomes. Further research is needed to determine risk factors that may increase disease severity and devise a proper risk-scoring system to initiate timely management.

symptoms are headache, nausea, and diarrhea [6] . Fever is the most prevalent reported symptom 73 [8] . Continuous fever, shortness of breath, and presence of respiratory and gastrointestinal 74 symptoms make a patient prone to develop severe disease. Moreover, the likelihood of intensive 75 care unit (ICU) admission, mechanical ventilation (invasive and non-invasive), and death is high 76 in such patients. In a study by Rongchen [9] Several studies have reported different mortality rates for patients admitted to different hospital 91 departments, such as the ICU, high-dependency unit, and general ward. Mortality is highest for 92 patients receiving IMV, followed by those managed with continuous positive airway 93 pressure/non-invasive ventilation, high-flow nasal cannula, and oxygen administered via other . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted March 25, 2022. ; https://doi.org/10.1101 https://doi.org/10. /2022 devices such as a simple face mask and nasal prongs [14] . The outcomes are good for patients 95 who do not require supplemental oxygen and hospital admission [15] .

The objective of the current study is to understand the demographic and clinical characteristics of 97 patients with COVID-19 and the associated severity of illness and outcomes. We sought to 98 perform an in-depth analysis of the various factors related to mortality, morbidity, and recovery 99 from COVID-19. In Pakistan, data are very limited on the clinical and demographic 100 characteristics of patients with COVID-19. Therefore, the results of this study will help us tailor 101 our management and preparedness response to the COVID-19 pandemic.

This article was previously presented as an abstract at the 14th Biennial Chest Conference 103 arranged by the Pakistan Chest Society at Karachi, Pakistan, on 4 December, 2021. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted March 25, 2022. ; https://doi.org/10.1101 https://doi.org/10. /2022 

This cross-sectional study was conducted from July 15, 2020, to July 3, 2021 in Peshawar,

Khyber Pakhtunkhwa, Pakistan. All patients admitted to the study hospital were included in our 109 study. Patients who were referred to another hospital or left without medical advice were 110 excluded from our study. Informed written consent was obtained from all patients at admission . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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This study assessed a total of 1087 patients, of whom 449 (41%) were female and 731 (67%) 124 were older than 50 years (Table 1) . Most had a fever (96.4%), cough (95.3%), shortness of 125 breath (72.7%), loss of taste (76.6%), and loss of smell (76.5%). Patients presented relatively less 126 commonly with headache (28.1%), rhinorrhea (32.8%), nausea and vomiting (12.8%), and 127 diarrhea (12.1%). Among comorbid conditions, hypertension (29.7%) and diabetes mellitus 128 (24.4%) were more common compared with ischemic heart disease (9%) and end-stage renal 129 disease (1.3%). The average length of hospital stay was 8.33 days. The overall mortality rate was 130 24.4% (268 patients) and was highest among those admitted directly to the ICU (49 of 56 131 patients, 88%) versus those admitted directly to the high-dependency unit (210 of 546 patients, 132 38%) and the general ward (9 of 485, 1.8%).

133 Table 1 . Frequency of various characteristics of study participants (n = 1087).

Below 50 Simple stratification (Table 2) showed that mortality was significantly higher in patients older 136 than 50 years (37% vs. 11%) and in those with shortness of breath (41% vs. 2%), diarrhea (60% . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted March 25, 2022. ; https://doi.org/10.1101/2022.03.24.22272884 doi: medRxiv preprint vs. 24%), nausea and vomiting (60% vs. 23%), diabetes mellitus (62% vs. 16%), hypertension 138 (53% vs. 18%), ischemic heart disease (74% vs. 24%), high level of disease severity (33% vs. 139 0%), and ICU admission (92% vs. 25%). Although mortality was also higher in female patients 140 (31% vs. 27%) and in those with fever (29% vs. 16%), and end-stage renal disease (100% vs. 141 28%), the association was not statistically significant. Some characteristics showed a statistically 142 significant protective effect from mortality, such as rhinorrhea (12% vs. 37%), loss of taste (2% 143 vs. 100%), and loss of smell (2% vs. 100%). Length of stay was also significantly higher in 144 patients who died compared with those who survived (11.43 vs. 7.63 days). . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) 

. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted March 25, 2022. ; https://doi.org/10.1101 https://doi.org/10. /2022 that were statistically significant are presented in Figure 1 . As can be inferred from the plots, 169 patients with fever (Fig 1A) , shortness of breath (Fig 1B) , ischemic heart disease (Fig 1C) , 170 nausea and vomiting (Fig 1D) , diabetes mellitus (Fig 1E) , and ICU admission ( Fig 1F) were 171 more likely to die compared with patients who did not have these signs and symptoms. the worst outcome as compared with patients who did not have these characteristics.

. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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The severity of any given disease depends on the population's demographic and clinical 179 characteristics [17] . Therefore, we aimed to study these factors to understand COVID-19 in 180 detail. This study will help us improve the management steps to prevent severe disease 181 outcomes. Clinicians and scientists are performing many kinds of studies to understand this 182 novel disease, which has killed millions of people. Many studies have already been conducted, 183 but with several drawbacks, such as a small sample size. Although this current investigation is a 184 single-site study, the hospital is an ideal location to examine the COVID-19 cohort because it 185 serves as a referral center for most of the province. This study included 1087 patients with 186 COVID-19 from a single tertiary care institution. Our hospital had an overall mortality rate of 187 24%, which is comparable with that of most nearby tertiary care hospitals. In a multi-center 195 Furthermore, symptoms such as nausea and vomiting (OR 3.9), fever (OR 3.5), and diarrhea, 196 (OR 1.52) predispose one to worse outcomes as well. In contrast, our study found that rhinorrhea 197 indicated a higher likelihood of recovery, which has not been reported previously. In a survey by . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted March 25, 2022. ; https://doi.org/10.1101 https://doi.org/10. /2022 Nausheen Nasir [19] et al. in Karachi, Pakistan, disease severity was associated with age older 199 than 60 years (OR 1.92) and having shortness of breath (OR 4.43 Pakistan discovered a link between the severity of COVID-19 and the number and type of 216 comorbidities. As the number of comorbidities increased, so did the disease severity. Patients 217 who were older, had diabetes, or had high blood pressure were more likely to have a poor 218 outcome.

. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted March 25, 2022. ; https://doi.org/10.1101 https://doi.org/10. /2022 Our study was conducted at a tertiary care hospital with a large sample size for one hospital. The 220 study sample was diverse because the patients were referred from throughout the province to this 221 tertiary care hospital. We evaluated both demographic and clinical characteristics to perform an 222 in-depth analysis.

The limitations of this study are that we did not include patients from other hospitals for 224 comparative analysis. Furthermore, we did not include the response to various treatments, and 225 lastly, the patient's social characteristics, such as local residence, occupation, and income, were 226 not included in this analysis.

Further research is needed to develop a comprehensive scoring system for COVID-19. The Our findings showed that older age, comorbidities, and direct admission to the ICU increase the 234 risk of worse outcomes. Furthermore, shortness of breath, fever, and gastrointestinal symptoms 235 also increase the risk of worse outcomes. In contrast, patients with isolated upper respiratory 236 symptoms have a lower mortality rate. More research is needed to determine risk factors that 237 increase the risk of disease severity and to devise a proper risk scoring system to initiate timely 238 management.

. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) Informed written consent was taken from all the participants.

. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

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An emerging coronavirus that causes a global threat

Mortality and Readmission Rates Among Patients With COVID-19 After Discharge From Acute 290

Population risk factors 293 for severe disease and mortality in COVID-19: A global systematic review and meta-analysis

Impacts of demographic and 296 clinical characteristics on disease severity and mortality in patients with confirmed COVID-19

Mortality and Associated risk factors in COVID-19 patients reported in ten 300 major hospitals of Khyber Pakhtunkhwa, Pakistan

It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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