Rai Deependra, Ranjan Alok, H Ameet, Pandey Sanjay
Respiratory Medicine, All India Institute of Medical Sciences, Patna, Patna, IND.
Community and Family Medicine, All India Institute of Medical Sciences, Patna, Patna, IND.
Cureus. 2021 Sep 2;13(9):e17660. doi: 10.7759/cureus.17660. eCollection 2021 Sep.
Introduction COVID-19 is associated with huge morbidity and mortality in India. Identification of factors associated with mortality would make a difference in the management of COVID-19 infection-related illness. Objective To assess clinical & laboratory parameters associated with adverse outcomes among 984 patients with COVID-19 infection admitted to a tertiary care hospital in eastern India. Materials and methods All patients with real-time polymerase chain reaction (RTPCR) or rapid antigen positive for COVID-19 admitted at our All India Institute of Medical Sciences (AIIMS) Patna between 1st July to 30th Aug 2020 were included for analysis. Statistical analysis was performed using Stata, version 10 (Stata Corp, College Station, USA). Four subgroup regression models have been analyzed to predict the odds of death. Results A total of 984 COVID-19 cases admitted to our hospital during the given period were analyzed. Out of 984 cases, 762 (77.44%) were males and 222 (22.56%) females. The overall case-fatality rate among admitted cases was 254 (25.81%) [males (26.64%) and females (22.96%)]. The final logistic regression model showed that patients presenting with severe COVID-19 disease (adjusted odds ratio [aOR]: 17.81), cough (aOR: 3.83), dyspnea (aOR:2.35), age 60-75 (aOR:1.47), age >75 years (aOR:3.97), presence of chronic kidney disease (CKD) (aOR:2.95), were found to be significantly associated with a high risk of mortality after controlling for the confounders (p<0.05). Among lab variable, total leukocyte count (TLC) (>10,000/mm3) (aOR: 1.74), neutrophil-lymphocyte ratio (NLR) (>3.3) (aOR:2.37), serum albumin (<3.4 g/dl) (aOR : 2.3), blood urea (>43 gm/dl) (aOR:3.72), ferritin (>322) (aOR:2.39), and D-dimer (>0.5) (aOR:5.58) were significantly associated with higher mortality (p<0.05) Conclusion Age 60 years plus, presence of CKD, and severe covid infection carried the highest risk of mortality. Lab markers such as raised TLC, ferritin, D-dimer, and low albumin were associated with worse outcomes in our subset of COVID-19-related illness.
引言
在印度，新型冠状病毒肺炎（COVID-19）与巨大的发病率和死亡率相关。识别与死亡率相关的因素将对COVID-19感染相关疾病的管理产生影响。
目的
评估印度东部一家三级医院收治的984例COVID-19感染患者中与不良结局相关的临床和实验室参数。
材料与方法
纳入2020年7月1日至8月30日期间在我们巴特那全印度医学科学研究所（AIIMS）因实时聚合酶链反应（RT-PCR）或快速抗原检测COVID-19呈阳性而收治的所有患者进行分析。使用Stata 10版本（美国德克萨斯州大学站市Stata公司）进行统计分析。分析了四个亚组回归模型以预测死亡几率。
结果
对我院在给定期间收治的984例COVID-19病例进行了分析。984例病例中，男性762例（77.44%），女性222例（22.56%）。收治病例的总体病死率为254例（25.81%）[男性（26.64%）和女性（22.96%）]。最终的逻辑回归模型显示，患有重症COVID-19疾病的患者（调整比值比[aOR]：17.81）、咳嗽（aOR：3.83）、呼吸困难（aOR：2.35）、年龄60 - 75岁（aOR：1.47）、年龄>75岁（aOR：3.97）、存在慢性肾脏病（CKD）（aOR：2.95），在控制混杂因素后（p<0.05），被发现与高死亡风险显著相关。在实验室变量中，总白细胞计数（TLC）（>10,000/mm³）（aOR：1.74）、中性粒细胞与淋巴细胞比值（NLR）（>3.3）（aOR：2.37）、血清白蛋白（<3.4 g/dl）（aOR：2.3）、血尿素（>43 gm/dl）（aOR：3.72）、铁蛋白（>322）（aOR：2.39）和D-二聚体（>0.5）（aOR：5.58）与较高死亡率显著相关（p<0.05）
结论
60岁及以上、存在CKD以及重症COVID-19感染具有最高的死亡风险。在我们的COVID-19相关疾病亚组中，实验室指标如升高的TLC、铁蛋白、D-二聚体和低白蛋白与更差的结局相关。
