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

Authors

  • Zia UlHaq Khyber Medical University
  • Muhammad Shahzad Khyber Medical University
  • Maria Ishaq Khattak Khyber Medical University
  • Sheraz Fazid Khyber Medical University
  • Naeem Ullah Saidu Group of Teaching Hospitals Swat, Khyber Pakhtunkhwa, Pakistan
  • Akhtar Sherin Khyber Medical University
  • Naeem Ulhaq
  • Asif Izhar Police Services Hospital Peshawar, Khyber Pakhtunkhwa, Pakistan
  • Umer Farooq MTI Ayub Medical College Abbottabad, Khyber Pakhtunkhwa, Pakistan
  • Nizam Muhammad Darwesh MTI Noweshera Medical College, Nowshera, Khyber Pakhtunkhwa, Pakistan
  • Muhammad Asim Northwest General Hospital Peshawar, Khyber Pakhtunkhwa, Pakistan
  • MianGul Ali Gohar Saidu Group of Teaching Hospitals Swat, Khyber Pakhtunkhwa, Pakistan
  • Amber Ashraf MTI Khyber Teaching Hospital Peshawar, Khyber Pakhtunkhwa, Pakistan
  • Saad Khattak Khyber Medical University Peshawar, Khyber Pakhtunkhwa, Pakistan
  • Saadia Ashraf MTI Khyber Teaching Hospital Peshawar, Khyber Pakhtunkhwa, Pakistan
  • Shahzad Akbar MTI Hayat Abad Medical Complex Peshawar, Khyber Pakhtunkhwa, Pakistan
  • Fawad Ullah MTI Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan
  • Muhammad Ismail MTI Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan
  • Amir Amanullah MTI Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan
  • AH Amir MTI Hayat Abad Medical Complex Peshawar, Khyber Pakhtunkhwa, Pakistan

Abstract

Background: COVID-19 is an ongoing public health issue across the world. Several risk factors associated with mortality in COVID-19 have been reported. The present study aims to describe clinical and epidemiological characteristics and predictors of mortality in hospitalized patients from Khyber Pakhtunkhwa, a province in Pakistan with highest COVID-19 associated case fatality rate. Methods: This multicentre, retrospective study was conducted in hospitalized COVID-19 patients who died or discharged alive until 1st May 2020. Data about sociodemographic characteristics, clinical and laboratory findings, treatment and outcome were obtained from hospital records and compared between survivors and non-survivors. Statistical tests were applied to determine the risk factors associated with mortality in hospitalized patients. Results: Of the total 179 patients from the 10 designated hospitals, 127 (70.9%) were discharged alive while 52 (29.1%) died in the hospital. Overall, 109 (60.9%) patients had an underlying comorbidity with hypertension being the commonest. Multivariate logistics regression analysis showed significantly higher odds of in-hospital death from COVID-19 in patients with multiple morbidities (OR 3.2, 95% CI 1.1, 9.1, p-value=0.03), length of hospital stay (OR 0.8, 95% CI 0.7, 0.9, p-value <0.001), those presenting with dyspnoea (OR 4.0, 95% CI 1.1, 14.0, p-value=0.03) and oxygen saturation below 90 (OR 9.6, 95% CI: 3.1, 29.2, p-value <0.001). Conclusion: Comorbidity, oxygen saturation and dyspnoea on arrival and length of stay in hospital (late admission) are associated with COVID-19 mortality. The demographic, clinical and lab characteristics could potentially help clinician and policy makers before potential second wave in the country. Keywords: COVID-19; Clinical Characteristics; Mortality; Khyber Pakhtunkhwa; Pakistan

Author Biography

Muhammad Shahzad, Khyber Medical University

Assistant Professor

References

Chakraborty I, Maity P. COVID-19 outbreak: Migration, effects on society, global environment and prevention. Science of The Total Environment. 2020 Aug 1;728:138882.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020 Mar 28;395(10229):1054–62.

Gupta N, Agrawal S, Ish P, Mishra S, Gaind R, Usha G, et al. Clinical and epidemiologic profile of the initial COVID-19 patients at a tertiary care centre in India. Monaldi Arch Chest Dis. 2020 Apr 10;90(1).

Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First Case of 2019 Novel Coronavirus in the United States. New England Journal of Medicine. 2020 Mar 5;382(10):929–36.

Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. New England Journal of Medicine. 2020 Mar 5;382(10):970–1.

COVID-19 Live Dashboard - Pakistan [Internet]. Google Data Studio. [cited 2020 Jul 19]. Available from: http://datastudio.google.com/reporting/1PLVi5amcc_R5Gh928gTE8-8r8-fLXJQF/page/R24IB?feature=opengraph

Alkundi A, Mahmoud I, Musa A, Naveed S, Alshawwaf M. Clinical characteristics and outcomes of COVID-19 hospitalized patients with diabetes in the United Kingdom: A retrospective single centre study. Diabetes Research and Clinical Practice. 2020 Jul 1;165:108263.

Ai J-W, Zi H, Wang Y, Huang Q, Wang N, Li L-Y, et al. Clinical Characteristics of COVID-19 Patients With Gastrointestinal Symptoms: An Analysis of Seven Patients in China. Front Med [Internet]. 2020 [cited 2020 Aug 14];7. Available from: https://www.frontiersin.org/articles/10.3389/fmed.2020.00308/full

Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020 Apr 7;323(13):1239–42.

Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. Journal of Infection [Internet]. 2020 Apr 23 [cited 2020 Jul 19]; Available from: http://www.sciencedirect.com/science/article/pii/S0163445320302346

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine. 2020 May 1;8(5):475–81.

Li H, Wang S, Zhong F, Bao W, Li Y, Liu L, et al. Age-Dependent Risks of Incidence and Mortality of COVID-19 in Hubei Province and Other Parts of China. Front Med (Lausanne). 2020 Apr 30;7:190–190.

Chen L, Yu J, He W, Chen L, Yuan G, Dong F, et al. Risk factors for death in 1859 subjects with COVID-19. Leukemia. 2020 Aug;34(8):2173–83.

Albitar O, Ballouze R, Ooi JP, Sheikh Ghadzi SM. Risk factors for mortality among COVID-19 patients. Diabetes Research and Clinical Practice [Internet]. 2020 Aug 1 [cited 2020 Aug 13];166. Available from: https://doi.org/10.1016/j.diabres.2020.108293

Wise J. Covid-19: Known risk factors fail to explain the increased risk of death among people from ethnic minorities. BMJ [Internet]. 2020;369. Available from: https://www.bmj.com/content/369/bmj.m1873

Asghar MS, Haider Kazmi SJ, Ahmed Khan N, Akram M, Ahmed Khan S, Rasheed U, et al. Clinical Profiles, Characteristics, and Outcomes of the First 100 Admitted COVID-19 Patients in Pakistan: A Single-Center Retrospective Study in a Tertiary Care Hospital of Karachi. Cureus. 2020 Jun 20;12(6):e8712–e8712.

Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. Journal of Infection. 2020 Aug 1;81(2):e16–25.

Hong K-H, Choi J-P, Hong S-H, Lee J, Kwon J-S, Kim S-M, et al. Predictors of mortality in Middle East respiratory syndrome (MERS). Thorax. 2018;73(3):286–9.

Choi KW, Chau TN, Tsang O, Tso E, Chiu MC, Tong WL, et al. Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong. Ann Intern Med. 2003 Nov 4;139(9):715–23.

Opal SM, Girard TD, Ely EW. The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis. 2005 Nov 15;41 Suppl 7:S504-512.

Zuin M, Rigatelli G, Zuliani G, Rigatelli A, Mazza A, Roncon L. Arterial hypertension and risk of death in patients with COVID-19 infection: Systematic review and meta-analysis. J Infect [Internet]. 2020 Apr 11 [cited 2020 Aug 14]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151373/

Apicella M, Campopiano MC, Mantuano M, Mazoni L, Coppelli A, Prato SD. COVID-19 in people with diabetes: understanding the reasons for worse outcomes. The Lancet Diabetes & Endocrinology [Internet]. 2020 Jul 17 [cited 2020 Aug 14];0(0). Available from: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30238-2/abstract

Leiva Sisnieguez CE, Espeche WG, Salazar MR. Arterial hypertension and the risk of severity and mortality of COVID-19. Eur Respir J. 2020 Jan 1;2001148.

Woolford SJ, D’Angelo S, Curtis EM, Parsons CM, Ward KA, Dennison EM, et al. COVID-19 and associations with frailty and multimorbidity: a prospective analysis of UK Biobank participants. Aging Clin Exp Res. 2020 Jul 23;1–9.

Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. International Journal of Infectious Diseases. 2020 May;94:91–5.

Zhang Y, Cui Y, Shen M, Zhang J, Liu B, Dai M, et al. Association of diabetes mellitus with disease severity and prognosis in COVID-19: A retrospective cohort study. Diabetes Research and Clinical Practice. 2020 Jul 1;165:108227.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 15;395(10223):497–506.

Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nature Reviews Cardiology. 2020 Sep;17(9):543–58.

Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. The Lancet. 2020 May 23;395(10237):1607–8.

Iaccarino Guido, Grassi Guido, Borghi Claudio, Ferri Claudio, Salvetti Massimo, Volpe Massimo, et al. Age and Multimorbidity Predict Death Among COVID-19 Patients. Hypertension. 2020 Aug 1;76(2):366–72.

Xie J, Covassin N, Fan Z, Singh P, Gao W, Li G, et al. Association Between Hypoxemia and Mortality in Patients With COVID-19. Mayo Clinic Proceedings. 2020 Jun 1;95(6):1138–47.

Downloads

Published

2021-01-16

Most read articles by the same author(s)

1 2 3 4 5 > >>