Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.
Institute for Developing Science & Health Initiatives (ideSHi), Dhaka 1216, Bangladesh.
Medicina (Kaunas). 2023 Jul 10;59(7):1280. doi: 10.3390/medicina59071280.
: The morbidity and mortality associated with COVID-19 have burdened worldwide healthcare systems beyond their capacities, forcing them to promptly investigate the virus characteristics and its associated outcomes. This clinical analysis aimed to explore the key factors related to the fatal outcome of severe COVID-19 cases. : Thirty-five adult severe COVID-19 patients were enrolled from two COVID-19 hospitals in Dhaka, Bangladesh. Clinical manifestation, comorbid conditions, medications, SARS-CoV-2 RT-PCR related cycle threshold (CT) value, hematology, biochemical parameters with SARS-CoV-2 specific IgG and IgM responses at enrollment were compared between the survivors and deceased participants. : Total 27 patients survived and 8 patients died within 3 months of disease onset. Deceased patients suffered longer from shortness of breath than the survived ( = 0.049). Among the severe cases, 62% of the deceased patients had multiple comorbid condition compared to 48% of those who survived. Interestingly, the anti-viral was initiated earlier among the deceased patients [median day of 1 (IQR: 0, 1.5) versus 6.5 (IQR: 6.25, 6.75)]. Most of the survivors (55%) received a combination of anticoagulant ( = 0.034). Liver enzymes, creatinine kinase, and procalcitonin were higher among the deceased patients during enrollment. The median CT value among the deceased was significantly lower than the survivors ( = 0.025). A significant difference for initial IgG ( = 0.013) and IgM ( = 0.030) responses was found between the survivor and the deceased groups. The factors including older age, male gender, early onset of respiratory distress, multiple comorbidities, low CT value, and poor antibody response may contribute to the fatal outcome in severe COVID-19 patients. Early initiation of anti-viral and a combination of anticoagulant treatment may prevent or lower the fatality among severe COVID-19 cases.
: 与 COVID-19 相关的发病率和死亡率使全球医疗体系不堪重负，迫使它们迅速调查病毒特征及其相关结果。本临床分析旨在探讨与重症 COVID-19 病例死亡结局相关的关键因素。 : 从孟加拉国达卡的两家 COVID-19 医院招募了 35 名成人重症 COVID-19 患者。比较了幸存者和死亡参与者在发病后 3 个月内的临床表现、合并症、药物、SARS-CoV-2 RT-PCR 相关循环阈值（CT）值、血液学、生化参数以及 SARS-CoV-2 特异性 IgG 和 IgM 反应。 : 共有 27 名患者存活，8 名患者在发病后 3 个月内死亡。死亡患者的呼吸急促持续时间长于存活患者（ = 0.049）。在重症病例中，62%的死亡患者有多种合并症，而存活患者为 48%。有趣的是，死亡患者更早开始使用抗病毒药物[中位数第 1 天（IQR：0，1.5）与 6.5 天（IQR：6.25，6.75）]。大多数幸存者（55%）接受了抗凝剂的联合治疗[ = 0.034]。在入组时，死亡患者的肝酶、肌酸激酶和降钙素原较高。死亡患者的 CT 值中位数明显低于存活患者（ = 0.025）。在幸存者和死亡组之间，初始 IgG（ = 0.013）和 IgM（ = 0.030）反应存在显著差异。年龄较大、男性、呼吸窘迫早期发作、多种合并症、低 CT 值和抗体反应不良等因素可能导致重症 COVID-19 患者死亡结局。早期使用抗病毒药物和抗凝剂联合治疗可能预防或降低重症 COVID-19 病例的死亡率。
