To explain the demographics of the COVID-19 patients admitted to selected hospitals - To elaborate on each clinical feature of COVID-19 positive patients. Recently identified, SARS-CoV-2 has been classified as subgenus Sarbecovirus of the lineage B lineage of betacoronaviruses (Letko, et al., 2020). Due to its widespread availability, high genetic diversity, and frequent recombination of the different coronavirus species, along with the increased time humans spend with animals, coronaviruses may occasionally mutate to infect human hosts (Zhu, et al., 2020).
Humans have been infected with corona virus for a long time, as it is one of the viruses responsible for the common cold (Boopathi, et al., 2021). This suggested that civets were probably not the primary hosts or natural reservoirs of the virus (Li, 2005; Wang, et al., 2006). 7 alveoli as well as the enterocytes in the small intestine (Hamming, et al., 2004), infection routes and disease manifestation can be understood from this.
Three important pro-inflammatory cytokines of the innate immune response are IL-1, TNF-α, and IL-6. However, contrary to this, in Covid-19 infections, the number of lymphocytes decreases as the severity of the disease increases (Schulte-Schrepping, et al., 2020).
Association of hematological and biochemical markers with COVID-19 infections While the clinical characteristics of COVID-19 are diverse, recent studies have also shown
12 In the case of cardiac markers, one meta-analysis of 28 studies found that critically ill patients with COVID-19 had increased levels of creatinine-kinase-MB, troponin, myoglobin, and NT-proBNP. In addition, another study by Deng et al (2020) found that most patients had normal troponin levels on admission, but in about 37.5% of cases the levels increased during the hospital stay, especially in those who died. Nevertheless, drug-induced liver injury could not be ruled out in this study (Cai et al., 2020).
Kidney disease in patients with COVID-19 may manifest as proteinuria, hematuria, or acute kidney injury, contributing to increased mortality risk. The viral antigen was found in the tubules of all kidney tissue samples (Diao, et al., 2020). Another study showed abnormal renal parameters, such as proteinuria, hematuria, and leukocyturia, on a routine admission urine test in COVID-19 patients without any history of renal disease (Zhou, et al., 2020).
This is why amylase and lipase levels are useful for follow-up purposes (Wang, et al., 2020). One study reported that 17% of patients with pneumonia due to COVID-19 also showed higher levels of amylase or lipase (Wang, et al., 2020).
Disease burden
Regarding liver markers, one study found that more than 90% of patients with abnormal liver tests had mild symptoms on admission. However, patients with abnormal hepatocellular or mixed liver tests on admission were at greater risk of developing severe disease. Postmortem histopathological renal examination of patients who died of COVID-19, one study found that SARS-CoV-2 infection caused severe acute tubular necrosis and lymphocyte infiltration.
To this is added the attitudes and practices of the general population regarding disease awareness and spread. Many do not take proper measures and despite several warnings and strict regulations, overcrowding remains. Once again, the infection of healthcare workers who are on the front lines fighting this disease has worsened the situation to such an extent that there are not enough workers to cope with the excessive disease burden.
One ray of hope that could stop this deadly disease is the advent of effective vaccines (Fiske et al., 2022).
Prevention
Treatment
Depending on the need, the different oxygen supply devices can be used: Nasal cannula (up to 5 liters), Oxygen mask (6-10 liters) and non-Rebreather bag with reservoir bag (10-15 liters. Other medications such as tocilizumab and baricitinib are used in severe or critical COVID-19 based on patient needs (MOHFW, 2020).
Materials and Methods
- Description of the study area
- Ethical consideration
- Study Design
- Inclusion and exclusion criteria Inclusion criteria
- Method of data collection
- Variables used
- Statistical analysis
Where n is the desired sample size, z is the standard normal deviation, and d is the allowable margin of error. However, due to the six-month time limit, as many as 306 patients could be included in this study. Patients over 18 years of age who were hospitalized during the study period with symptoms of COVID-19 and an RT-PCR positive for SARS CoV-2.
Based on national guidelines for the clinical management of COVID-19 (DGHS, 2021), all suspected/confirmed cases of COVID-19 with the following presentations were hospitalized. All patients who were admitted to the COVID unit, had a positive RT-PCR test and were over the age of 18 were considered for this study. After that, routine clinical and laboratory examinations were performed and the patient was managed as needed.
Information on laboratory findings and patient management was obtained from the patient's medical record and the patient's condition was followed until the patient's discharge or death. Patient outcome - died in hospital, recovered, referred to other hospitals or discharged due to risk insurance (DORB).
Results
Demographic characteristics of the patients
As observed, the variables age and number of affected family members had a significant correlation with the patient's death. For gender, the majority of patients who died were male patients with a male to female death ratio of 4:1. Although not as significant, patients without travel history or contact with infected persons were more likely to have a worse outcome.
Regarding affected family members, patients with a history of one affected family member had a significantly higher risk of death (p=0.046). In the case of vaccination status, only 5 (1.6%) of 306 subjects received at least one dose of vaccine.
Risk factors among the patients
To find out the different types of risk factors and their relationship with patient outcome, a univariate analysis was performed for the different risk factors among the patients using chi-square test. The table above shows the different risk factors that were present among COVID-19 patients and their relationship with patient outcome. To compare the differences in mean duration of signs and symptoms between patients who survived and patients who died, a univariate analysis was performed with the patient's death as the dependent variable.
The table above shows the relationship between the duration of the patient's signs and symptoms and the patient's death. A significant difference was observed in the mean duration of signs such as crackles (p=0.04), wheezing (p<0.001) and bronchial breath sounds (p=0.033).
Hematological and biochemical parameters of the study subjects
The table shows that the mean values of sodium (p=0.002), potassium (p=0.011) and bicarbonate (p=0.001) were significantly lower in patients who expired. Patients who died in hospital showed a significantly higher mean for NT Pro BNP (p = 0.045) and troponin I (p = 0.001).
Management of study subjects during hospital admission
Of the medications prescribed to patients, enoxaparin (76.8%) was the most common, followed by the glucocorticoid dexamethasone (41.5%), the antiviral remdesivir (17%), methylprednisolone (7.5%), ivermectin (1.3%) and Favipiravir Result of the subjects.
Discussion
This is consistent with the study by Havers, et al., (2021) where vaccinated people were less likely to be admitted unless they were old or had at least three underlying medical conditions. Vahey, et al., (2021) report that taking opioids, metabolic syndrome, obesity, hypertension and arrhythmia are significantly associated with hospitalization of COVID-19 patients. Another study by Wang, et al., (2020), states that patients with pre-existing diabetes mellitus, hypertension, cardiovascular diseases or respiratory diseases are more critically ill requiring hospital admissions.
The association between smoking and increased severity of COVID-19 has been reported in several studies (Reddy et al., 2021; Patanavanich and Glantz, 2020). In another study (Soares et al., 2020), common clinical symptoms were cough, fever, headache, runny nose, sore throat, shortness of breath, and diarrhea. This is similar to another study conducted in Chattogram where 82.8% of patients required supplemental oxygen (Biswas et al., 2021).
However, at the national level, it is much lower than two other studies conducted in Bangladesh (Biswas, et al., 2021) (Chowdhury, et al., 2021). 35 somewhat comparable to a study by (Wang, et al., 2020) in which deceased patients were more likely to have hypertension, cardiovascular disease or diabetes. In a study by Verity et al. (2020), the average duration from the onset of symptoms to death is estimated at 17.8 days.
Pan et al. (2020) found that SPO2 and diastolic pressure were significantly different between patients who survived and patients who died. According to a study (Tezcan, et al., 2020), hyponatremia was one of the independent factors associated with mortality from COVID-19. Our findings are similar to another study conducted by (Henry et al., 2020), where a significant increase in white blood cells and a decrease in neutrophils and platelets were observed.
Similar results were reported in the study by Henry, et al., (2020), where a significant increase in CRP, ferritin and procalcitonin was reported. Another study by (Gao, et al., 2020), reports that NT-Pro BNP is significantly elevated among patients who have a negative result for COVID-19 - a similar finding to our study. Another study by (Selçuk, et al., 2021) reported elevated levels of glucose, Troponin I, NT-Pro BNP and creatinine levels, all of which were stable in our study.
Conclusion
Limitations
Recommendations
Hematologic, biochemical, and immunologic biomarker abnormalities associated with severe morbidity and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Association of age, sex, comorbidities, and clinical symptoms with severity and case fatality of COVID-19: a meta-analysis of 85 studies and 67,299 cases. Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other B-lineage betacoronaviruses.
A comprehensive overview of SARS-CoV-2 genetic mutations and lessons from animal coronavirus recombination from a single health perspective. Factors associated with mortality in patients with severe coronavirus disease-19 (COVID-19): a case-control study. Role of the clinical laboratory in the COVID-19 epidemic: overview of available diagnostic methods and their limitations.
Detecting new clinical manifestations in patients with COVID-19 in Chile and its possible relationship with the SARS-CoV-2 divergence. Clinical predictors of mortality from COVID-19 based on an analysis of data from 150 patients from Wuhan, China. Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without history of heart failure.
