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Clinical Characteristics of 47 Death Cases With COVID-19: A Retrospective Study at a Tertiary Center in Lahore
Ahmad Ussaid1, Babar Riaz1, Wajid Rafai1
1Internal Medicine, University College of Medicine and Dentistry, University of Lahore Teaching Hospital, Lahore, PAK.
Insights
This study found that older males with diabetes and hypertension were most affected by severe COVID-19, often leading to acute respiratory distress syndrome (ARDS). Elevated D-dimer and neutrophil-to-lymphocyte ratio indicated a poor prognosis in these patients.
Area of Science:
- Medical Research
- Infectious Diseases
- Pulmonology
Background:
- Coronavirus disease 2019 (COVID-19) exhibits a broad clinical spectrum, from asymptomatic cases to fatal acute respiratory distress syndrome (ARDS).
- Understanding COVID-19 patient characteristics and disease progression is crucial for effective management and improved outcomes.
Purpose of the Study:
- To analyze the epidemiological, biochemical, clinical, and radiological features of deceased COVID-19 patients.
- To identify factors associated with mortality in severe COVID-19 cases.
Main Methods:
- A retrospective observational study of 47 deceased COVID-19 patients at the University of Lahore Teaching Hospital.
- Evaluation of patient data including comorbidities, symptoms, laboratory markers (D-dimer, ferritin, CRP, neutrophil-to-lymphocyte ratio), and chest radiography (mRALE score).
Main Results:
- The cohort comprised males (mean age 61.5 years) with prevalent comorbidities like diabetes (68.1%) and hypertension (12.8%).
- Predominant symptoms included cough (95%) and shortness of breath (93%). Bilateral lung involvement (85.11%) with a mean mRALE score of 18.78 was common.
- Elevated D-dimer (1567.13 ng/mL) and neutrophil-to-lymphocyte ratio (10.50) were observed. ARDS was the most frequent cause of death (25.5%).
Conclusions:
- Severe COVID-19 disproportionately affects older males with chronic comorbidities, leading to multisystem involvement and mortality.
- Elevated D-dimer and neutrophil-to-lymphocyte ratio are potential indicators of poor prognosis.
- Antimicrobial combinations showed no benefit; the efficacy of tocilizumab and remdesivir remains uncertain due to limited use.
Abstract:
Introduction Coronavirus disease 2019 (COVID-19) presents with a wide spectrum of symptoms, ranging from patients being asymptomatic to having life-threatening acute respiratory distress syndrome (ARDS). COVID-19 emerged as a pandemic and has led to multiple causalities worldwide. A better understanding of the clinical characteristics of the COVID-19 patients and their disease course will aid in better management of these patients and hence may positively impact their outcomes as well. Methodology This was a retrospective observational study conducted from April 15, 2020, to August 31, 2020, after gaining institutional review board approval at the University of Lahore Teaching Hospital, Lahore, Pakistan. A total of 47 patients with severe disease who had died due to COVID-19 during this period were enrolled by the consecutive method. Patients were evaluated for their epidemiological, biochemical, clinical, and radiological features. The modified Radiographic Assessment of Lung Edema (mRALE) score was used to calculate the extent of alveolar opacities and percentages of lung involvement in chest radiographs. Furthermore, patients' management plans were also evaluated. Data were analyzed using SPSS Statistics version 23 (IBM, Armonk, NY). Results The mean age of the patients was 61.53 ±13.35 years. The male-to-female ratio was 2:1, and the mean BMI was 28.05 ±3.52 kg/m2. Diabetes was the most prevalent comorbidity among the patients (32, 68.1%), followed by hypertension (six, 12.8%), ischemic heart disease (five, 10.6%), and chronic kidney disease (four, 8.5%) respectively. The predominant symptom observed among patients was cough (95%), followed by shortness of breath (93%), fever (63%), sputum (23%), and gastrointestinal symptoms (6.4%). The mean D-dimer was 1,567.13 ±1,903.77 ng/mL, mean ferritin was 1,730.34 ±1,382.35 ng/mL, mean C-reactive protein (CRP) was 202.59 ±104.97 mg/dl, and the mean neutrophil-to-lymphocyte ratio was 10.50 ±9.58. Bilateral lung involvement was seen among 40 (85.11%) patients whereas unilateral right lung involvement was reported in three (6.38%) and unilateral left lung involvement in four (8.51%) respectively. The mean mRALE score for bilateral lung involvement was 18.78 ±4.89. The mean area radiologically involved in bilateral lung fields was 72.12 ±18.45%, followed by unilateral right lung involvement of 67.87 ±15.97%, and unilateral left lung involvement of 61.38 ±17.95% in the cohort respectively. The most common type of radiological pathology was diffuse ground-glass opacities, which was observed in 18 (38%) patients. Most patients received antibiotics (39, 63.83%), while nine (19%) received tocilizumab, four (8.5%) had antiviral therapy, and three (6.4%) were given plasma treatment. All patients received glucocorticoids and anticoagulation. The most common cause of death was ARDS, which was observed in 12 (25.5%) patients. Conclusion This study significantly demonstrated that most cases were males above 50 years of age with chronic medical comorbidities of diabetes, hypertension, and ischemic heart disease. COVID-19 has a predilection for multisystem involvement leading to mortality. In addition, elevated D-dimer and neutrophil-to-lymphocyte ratio may be indicative of a poor prognosis. A combination of antimicrobials had no positive impact on the outcomes in this cohort. It is difficult to predict the efficacy of tocilizumab and remdesivir as only a few patients in the cohort received these drugs.