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Published on: December 19, 2020
An Update on Initial Epidemiological Profile, Clinical Course, and Outcome of COVID-19 Patients at a Tertiary Care
Dimple Pande1, Anjali Kochhar1, Suman Saini1
1Department of Anaesthesia and Critical Care, VMMC and Safdarjung Hospital, New Delhi, India.
Insights
Critically ill COVID-19 patients in India, often middle-aged with comorbidities, experienced severe disease. This study highlights a high mortality rate of 59.2% in intensive care unit (ICU) admissions.
Area of Science:
- Intensive Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Coronavirus disease 2019 (COVID-19) pandemic presents a spectrum of illness, from mild to critical.
- Data on critically ill COVID-19 patients requiring intensive care unit (ICU) admission in India is limited.
- Initial observations in India indicated milder disease in younger populations, later shifting to increased severity in older age groups.
Purpose of the Study:
- To describe the initial experience of an Indian ICU with critically ill COVID-19 patients.
- To analyze the epidemiological profile, clinical course, and outcomes of these patients.
- To provide insights into the management and characteristics of severe COVID-19 cases in the Indian context.
Main Methods:
- A case series of 27 consecutive laboratory-confirmed COVID-19 patients admitted to a tertiary care ICU.
- Data collection included demographic, clinical, laboratory, and radiological findings, with a focus on comorbidities.
- Patients were followed up until ICU discharge, with management following institutional protocols.
Main Results:
- The median patient age was 50 years; 85% had comorbidities, most commonly diabetes (43.7%) and hypertension (37.5%).
- Fever was the most common symptom; 88.8% had bilateral lung infiltrates on chest X-ray.
- Mortality rate in the ICU was high at 59.2%, with 62.9% requiring ventilatory support.
Conclusions:
- Middle-aged patients with comorbid conditions are prone to severe COVID-19 disease.
- Critically ill COVID-19 patients admitted to Indian ICUs exhibit a poor outcome.
- Comorbidities significantly influence the severity and prognosis of COVID-19.
Background And Aim:
Coronavirus disease 2019 (COVID-19) has become a global pandemic with the spectrum of disease from asymptomatic or mild disease to severe cases requiring intensive care unit (ICU) admission. In India, it started with milder presentation affecting younger population. Later on, an increase in disease severity was observed involving older age group as well. However, there is a paucity of published data regarding patients requiring ICU care in India. This case series describes the initial experience of an ICU in India regarding epidemiological profile, clinical course, and outcome of critically ill COVID-19 patients.
Methods:
This case series included 27 consecutive laboratory-confirmed COVID-19 patients who were admitted in a tertiary care ICU over 14 days period, followed up till their discharge from ICU. Demographic and clinical data, including laboratory and radiological findings, were compiled with special attention to co-morbidities of the patients. The management of these patients was done as per the institutional protocol for critically ill COVID-19 patients.
Results:
The median age of the patients was 50 years with no difference in gender. Comorbid conditions were seen in 85% of the patients with diabetes (43.7%) and hypertension (37.5%) as the most common conditions. The median duration of symptoms before admission was 6 days with fever as the most common clinical symptom at presentation. Chest roentogram showed bilateral lung infiltrates in 88.8% of the patients. Mild, moderate, and severe hypoxia were observed in 3, 8, and 16 patients, respectively. Ten patients were managed with oxygen therapy. Seventeen patients (62.9%) required ventilatory support. Mortality rate among patients admitted to our ICU was 59.2%.
Conclusions:
This case series shows middle-aged patients with comorbid diseases present with severe COVID-19 disease and have poor outcome.
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