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Clinical Profile and Outcome of Critically-ill Hospitalized COVID-19 Patients Aged 18-50 Years: A Limited Resource
Minal Shastri1, Raj Vekaria2, Darshankumar Manubhai Raval2
1Professor, Department of Medicine, Government Medical College, Baroda, Gujarat, India.
Insights
Critical illness in young and middle-aged adults with COVID-19 is linked to multiple comorbidities, lung abnormalities, and elevated inflammatory markers like D-dimer and ferritin, increasing mortality risk. Tocilizumab showed a positive impact on outcomes.
Area of Science:
- Critical care medicine
- Infectious diseases
- Pulmonology
Background:
- The COVID-19 pandemic has increasingly affected younger populations, including young and middle-aged adults.
- Understanding risk factors and prognostic markers in these age groups is crucial for effective management.
Purpose of the Study:
- To clinically evaluate critically ill young and middle-aged adults hospitalized with COVID-19.
- To investigate the association of risk factors, inflammation, and coagulation markers with patient outcomes.
Main Methods:
- A prospective observational study involving 146 patients in Western India.
- Clinical evaluation, laboratory investigations, and chest X-rays were performed, with repeat investigations after 3 days.
- Standard treatment protocols, including ventilation, were followed.
Main Results:
- Difficulty in breathing was the most common symptom; most patients had normal temperature on admission.
- Chest X-ray findings (>2 lung zones), high neutrophil-to-lymphocyte ratio, complications, elevated D-dimer and serum ferritin, and invasive ventilation correlated with higher mortality.
- Multiple comorbidities significantly increased mortality, unlike a single comorbidity.
Conclusions:
- Multiple comorbidities, complications, radiological abnormalities, and elevated D-dimer/serum ferritin are associated with increased mortality in critically ill COVID-19 patients.
- Tocilizumab administration was associated with decreased mortality, while remdesivir showed no significant impact.
- An inflammatory marker scoring system may aid in patient prognosis, particularly in resource-limited settings.
Objectives:
The coronavirus disease of 2019 (COVID-19) pandemic started by affecting the older age groups with comorbidities but gradually advanced to severely affect even young adults. This study attempts to clinically evaluate critically ill young and middle-aged adults hospitalized with COVID-19 and study the association of risk factors and the markers of inflammation and coagulation with their outcome.
Materials And Methods:
A prospective observational study on 146 patients was conducted in a tertiary care hospital in Western India. History taking, clinical examination, laboratory investigations, and chest X-rays were done for all patients, and investigations were repeated after 3 days. Treatment, including ventilation, was given according to standard guidelines.
Results:
Difficulty in breathing was the most common chief complaint, and the majority of patients had a normal body temperature on admission. Involvement of >2 lung zones on chest X-ray, a high neutrophil to lymphocyte (N/L) ratio, the presence of complications, raised D-dimer and serum ferritin, and invasive ventilation were all associated with higher mortality. While the presence of a single comorbidity did not affect the outcome, a combination of multiple comorbidities increased the mortality.
Conclusion:
The presence of multiple comorbidities and complications along with radiological abnormalities and raised D-dimer and serum ferritin are associated with critically ill COVID-19 patients and may indicate a higher risk of mortality. Administration of remdesivir has no significant influence on the outcome, but tocilizumab decreases the mortality. The inflammatory markers scoring system has utility in the prognosis of patients, especially in limited-resource settings.
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