scholarly journals The Role of Laboratory Parameters in Assessment of Disease Severity and Outcome in COVID-19 patients – A Retrospective Study in a Tertiary Care Centre in Southern India

2021 ◽  
Vol 8 (7) ◽  
pp. A164-173
Author(s):  
Rajeshwari B ◽  
Salapathi Shanmugam ◽  
Anila Mathan ◽  
Dhananjayan R ◽  
Isabella Princess B ◽  
...  
Keyword(s):  
Virus Disease ◽  
Severe Disease ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Initial Assessment ◽  
P Value ◽  
Laboratory Parameters ◽  
Severity Of The Disease ◽  
Laboratory Biomarkers ◽  
Time Of Admission

Background: Corona Virus Disease 2019 (COVID19) is a global pandemic, the outbreak of which started in China in December 2019. Apart from the clinical symptoms and pulmonary computed tomography (CT) findings, several laboratory biomarkers also play an important role in management of these patients so that immediate attention can be given to those with severe disease and critical illness. In this study we tried to find the association of various laboratory biomarkers in COVID-19 patients, analyzed around the time of admission, with the severity of the disease and outcome. Methods: In this study 1048 COVID19 positive cases admitted in our hospital during the study period from April 2020 to October 2020 were included. The cases were clinically assessed based on the severity of the disease at the time of presentation and during the course in hospital and categorized into 3 categories as Mild, Moderate and Severe according to our hospital protocol for management of COVID 19 patients. The clinical and laboratory data were retrieved from electronic medical records. The levels of various laboratory parameters at/around the time of admission were compared with clinical categories, severity and outcome of the disease. Result: We found a statistically significant association of severity and outcome of COVID-19 with various laboratory parameters. There were significantly higher levels of D-dimer, LDH, CK, CRP, Sr Ferritin, cTnI, NT pro BNP, PCT, IL-6 and lower ALC in non survivors compared to survivors and in severe disease compared to mild disease with a p value of <0.05. Conclusion: In this study we propose that along with the initial clinical assessment, age and concurrent co-morbidities of COVID-19 patients which determine the need for their admission to ICUs, the initial assessment of several laboratory parameters is helpful in triaging the patients who need intensive care so that proper allocation of resources can be done.

scholarly journals Role of BAP 65 (Blood Urea Nitrogen, Altered Mental Status, Pulse, Age 65 Years) Scoring System in Risk Stratification of Patients with Acute Exacerbation of Chronic Obstructive Lung Disease in Tertiary Care Hospital

2019 ◽  
Vol 2 (2) ◽  
pp. 5-10
Author(s):  
Ashish Thapa
Keyword(s):  
Mechanical Ventilation ◽  
Acute Exacerbation ◽  
Severe Disease ◽  
Tertiary Care ◽  
Chronic Obstructive Lung Disease ◽  
Institutional Review Boards ◽  
Mortality Data ◽  
Chronic Obstructive ◽  
P Value ◽  
Care Hospital

Introduction: Exacerbations are important events in the management of COPD because they negatively impact health status, rates of hospitalization and readmission, and disease progression. COPD AE is one of the commonest case presenting to the TUTH Emergency, average being 5 patients a day. The aim of the study was to co-relate the BAP 65 score, mortality and mechanical ventilation in patients with acute exacerbation of COPD. Methods: It was an observational study, 648 patients from emergency of TUTH were screened for the study from Magh 2073 to Asar 2074 after getting approval from the institutional review boards, among them 114 were included after applying inclusion and exclusion criteria and BAP 65 score was calculated. The patients were followed till discharge, mechanical ventilation or mortality. Data entry was done in MS EXCEL and statistical analysis was done using SPSS version 24. Results: Total of 114 patients enrolled for the study from the emergency of TUTH. There were total 16 mortality and 12 patients were mechanically ventilated. Most of the mortality and mechanical ventilation were from severe group ie BAP class IV and V. We used Pearson Chi-squared test to compare between BAP 65 class and Mortality, and found that mortality rate increased with increasing BAP 65 class with a p value of < 0.0001. The need of Mechanical Ventilation increased as well, as the BAP 65 Class increased, less than 1% of the patients with BAP class I needed MV, the cause being Type II Respiratory Failure, while around 50% of the patients with BAP class V needed MV. Conclusions: BAP 65 score is an effective and simple tool to classify the patients presenting with AECOPD, it correlated well with both the need of mechanical ventilation and mortality. Higher the score higher the chances of severe disease.

scholarly journals Predictors of mortality in adult patients with dengue: a study from South India

2018 ◽  
Vol 6 (5) ◽  
pp. 1605 ◽  
Author(s):  
Vasudeva Acharya ◽  
Mohammed Fahad Khan ◽  
Srinivas Kosuru ◽  
Sneha Mallya
Keyword(s):  
Renal Failure ◽  
Prothrombin Time ◽  
Tertiary Care ◽  
P Value ◽  
Bleeding Tendency ◽  
Care Hospital ◽  
Laboratory Parameters ◽  
Prolonged Prothrombin Time ◽  
Risk Of Death ◽  
Increased Risk

Background: Dengue is one of the important causes of acute febrile illnesses in India. Dengue can be a fatal disease, however there are no reliable markers which can predict mortality among these patients.Methods: A prospective cross sectional study was done in patients who were admitted to a tertiary care hospital with features of dengue fever. A total of 364 patients with IgM dengue serology positive were included in the study. Relevant clinical and laboratory parameters were collected from all patients. Association between clinico-laboratory parameters with mortality was studied using appropriate statistical methods.Results: Among the 364 patients recruited in this study, 14 (3.85%) patients died. Mortality among patients with age group 18-40 years was 2.04%, in patients aged above 40 years was 7.56%. Mortality among patients with hypotension was 42.42% (14 out of 33), bleeding manifestations was 15.38% (8/52), platelets <20,000/mm3 was 10.41% (10/96), ALT >200 was 13.04% (6/46), AST>200 was 12.34% (10/81), prolonged prothrombin time was 60%(12/20), renal failure was 28%(14/50), encephalopathy was 31.57% (6/19), multi organ dysfunction syndrome(MODS) was 43.33% (13/30), acute respiratory distress syndrome (ARDS) was 45.45% (5/11), pleural effusion was 7.5% (6/80).Conclusions: The overall mortality in the present study was 3.85%. Following variables were associated with increased risk of death among the dengue patients: Age >40 years, presence of hypotension, platelets <20000 cells/mm3, ALT>200U/L, AST>200U/L, prolonged prothrombin time, presence of renal failure, encephalopathy, MODS, ARDS and bleeding tendency (p value <0.05). Early identification of factors associated with mortality can help to make appropriate decision on care required.

scholarly journals Acute febrile encephalopathy and its outcome among children in a tertiary care hospital

2018 ◽  
Vol 5 (2) ◽  
pp. 503
Author(s):  
Anusha Deepthi C. H. ◽  
Arigela Vasundhara ◽  
Sourika P. ◽  
Sravya G. S.
Keyword(s):  
Viral Encephalitis ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Complete Recovery ◽  
P Value ◽  
Care Hospital ◽  
Cns Infections ◽  
Appropriate Treatment ◽  
Common Causes ◽  
Time Of Admission

Background: Acute febrile encephalopathy (AFE) is a common condition leading to hospitalization of children in India. Majority of the studies revealed etiology of AFE, but very few studies emphasized on predictors of mortality. This study was conducted to observe the outcome in relation to etiology and Glasgow coma score at admission.Methods: This prospective study was carried out on 84 children between 2 months to 14 years, with fever duration of <14 days, GCS ≤12 at the time of admission and altered sensorium in the pediatric intensive care unit over a period of 18 months (December 2011 to June 2013). Patients were evaluated daily till discharge/death. Outcome was evaluated in terms of complete recovery, morbidity and mortality.Results: In this study, AFE was higher among the age group of 6-14 years (54.7%) with most common cause being viral encephalitis (38%). Higher mortality rates were observed in CNS infections. Persistent seizures and hemiparesis were the most common causes of morbidity. GCS at initial presentation <7 was significantly associated with mortality, p value being 0.036.Conclusions: CNS infections are the leading cause of febrile encephalopathy and also associated with high mortality. Persistent seizures and hemiparesis being most common causes of morbidity. Low GCS at the time of admission and longer duration of coma are associated with higher risk of morality. Most of the morbidities were observed in CNS infections and as most of them were curable, early institution of appropriate treatment will decrease morbidity. 

scholarly journals A Novel Scoring System for Early Assessment of the Risk of the COVID-19-associated Mortality in Hospitalized Patients: COVID-19 BURDEN

2022 ◽  
Author(s):  
Fatemeh Amirzadehfard ◽  
Mohammad Hossein Imanieh ◽  
Sina Zoghi ◽  
Faezeh sehatpour ◽  
Peyman Jafari ◽  
...  
Keyword(s):  
Risk Score ◽  
Scoring System ◽  
Virus Disease ◽  
Multiple Logistic Regression Analysis ◽  
Laboratory Data ◽  
Area Under The Curve ◽  
Diagnostic Efficiency ◽  
Early Assessment ◽  
Severity Of The Disease ◽  
Care Costs

Background: Corona Virus Disease 2019 (COVID-19) presentation resembles common flu or can be more severe; it can result in hospitalization with significant morbidity and/or mortality. We made an attempt to develop a predictive model and a scoring system to improve the diagnostic efficiency for COVID-19 mortality via analysis of clinical features and laboratory data on admission. Methods: We retrospectively enrolled 480 consecutive adult patients, aged 21-95, who were admitted to Faghihi Teaching Hospital. Clinical and laboratory features were extracted from the medical records and analyzed using multiple logistic regression analysis. Results: A novel mortality risk score (COVID-19 BURDEN) was calculated, incorporating risk factors from this cohort. CRP (> 73.1 mg/L), O2 saturation variation (greater than 90%, 84-90%, and less than 84%), increased PT (>16.2s), diastolic blood pressure (≤75 mmHg), BUN (>23 mg/dL), and raised LDH (>731 U/L) are the features comprising the scoring system. The patients are triaged to the groups of low- (score <4) and high-risk (score ≥ 4) groups. The area under the curve, sensitivity, and specificity for predicting non-response to medical therapy with scores of ≥ 4 were 0.831, 78.12%, and 70.95%, respectively. Conclusion: Using this scoring system in COVID-19 patients, the severity of the disease will be determined in the early stages of the disease, which will help to reduce hospital care costs and improve its quality and outcome.

scholarly journals Clinical course and characteristics of Corona Virus Disease 2019 in Xiaoshan, Hangzhou: A Retrospective study

2020 ◽  
Author(s):  
Fenhua Lai ◽  
Yongtao Zheng ◽  
Hexiang Jia ◽  
Fuliang Wang ◽  
Xiangjue Sun ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Virus Disease ◽  
Descriptive Analysis ◽  
Laboratory Data ◽  
Scientific Basis ◽  
World Health ◽  
P Value ◽  
Chi Square ◽  
Course Of Disease ◽  
Corona Virus

Abstract Background: The World Health Organization declared the outbreak a public health emergency of international concern (Corona Virus Disease 2019) on January 30th, this study aimed to investigate the epidemiological and clinical characteristics of Corona Virus Disease 2019 in Xiaoshan, Hangzhou, and evaluate scientific basis for disease control and prevention. Methods: A total of 30 patients had been admitted to hospital from Jan 22 to Feb 22, 2020, all of them were laboratory confirmed SARS-Cov-2. Demographic, epidemiological, clinical, laboratory data were collected from Hospital information system and Epidemiological investigation reports. All data was performed by descriptive analysis, Chi-square test or non-parametric Mann-Whitney U test, as appropriate. Two sided p value less than 0.05 was considered statistically significant.Results: 30 patients were enrolled, the median age was 44.5 years (IQR 33.8-52.3) and 17 (56.7%) patients were female, 14 (46.7%) patients were native and had no exposure to Hubei Province. At the time of study submission, only one patient had not been discharged and no patients died during the study. The median hospital stay was 16.0 days (IQR 12.5-20.5) and the median course of disease was 20.5 days (IQR 17.0-23.3). The most common symptoms were fever (66.7%), dry cough (26.7%), and pharyngalgia (23.3%) on first admission. Most patients were generally illness or more mild, but 10 (33.3%) patients received oxygen therapy and 14 (46.7%) patients received hormone therapy during their hospitalization. Almost half of patients showed mild lymphocytopenia and 40% patients had elevated concentrations of CRP in the early stages of COVID-19.Conclusions: Among the 30 patients were confirmed with SARA-Cov-2 infection in Xiaoshan, Hangzhou, most of them had clinical presentation of respiratory tract infection, but the median course of disease was more than 2 weeks. Further systematic prospective studies about COVID-19 should be urgently needed.

scholarly journals Clinical Profile and Outcomes in Patients with Acute Intracerebral Haemorrhage Presenting to the Emergency Department at a Tertiary Care Teaching Hospital, South India

2021 ◽  
Vol 10 (21) ◽  
pp. 1575-1582
Author(s):  
Subramanyam Penubaku ◽  
Madhusudhan Mukkara ◽  
Kanchi Mitra Bhargav ◽  
, Ramesh Chandra V.V. ◽  
Sadasiva Raju S. ◽  
...  
Keyword(s):  
Intracerebral Haemorrhage ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Intraventricular Haemorrhage ◽  
World Health ◽  
P Value ◽  
Study Population ◽  
Ich Score ◽  
Gcs Score ◽  
Time Of Admission

BACKGROUND World Health Organisation (WHO) defined stroke as rapidly developing clinical signs of focal disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than vascular origin. Prognostic factors for predicting functional outcome and mortality play a major role in determining the treatment outcome. We intended to study the clinical charecteristics and outcome of patients with intracerebral bleeding coming to emergency room. METHODS Patients more than 18 years of age who were diagnosed to have intracerebral haemorrhage (ICH) on CT brain plain scan were included in the study. Age < 18 years, patients not willing to participate in the study were excluded from the study. Type of clinical presentation, imaging findings, ICH score, and Glasgow coma scale (GCS) score, were calculated for each patient at the time of admission. The condition of the patient, whether death / discharge (alive) was documented in all study population at the time of discharge. RESULTS Hypertension was the most common risk factor present in 68 % of study population. Most of the patients were between 41 - 70 years of age with a male preponderance. High ICH score, low GCS score at the time of admission, presence of intraventricular haemorrhage, and midline shift (P - value 0.000) were significantly associated with poor clinical outcome. Mortality was high in patients with infratentorial bleed and volume > 40 c.c. CONCLUSION Males in their sixth decade were the most affected in our study on ICH. Cerebellar and brainstem haemorrhages had higher mortality, though putamen is the commonest site of haemorrhage, low Glasgow Coma Scores and high ICH scores were associated with increased mortality. KEY WORDS Stroke, Haemorrhage, Intracerebral, Prognosis, Bleed

scholarly journals Epidemiological and Clinical Features of 2019 Novel Coronavirus Diseases (COVID-19) in the South of Iran

2020 ◽  
Author(s):  
Reza Shahriarirad ◽  
Zohre Khodamoradi ◽  
Amirhossein Erfani ◽  
Hamid reza Hossein pour ◽  
Keivan Ranjbar ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Laboratory Data ◽  
Ground Glass Opacity ◽  
International Normalized Ratio ◽  
P Value ◽  
Total Recovery ◽  
Source Of Infection ◽  
Severity Of The Disease ◽  
Novel Coronavirus ◽  
Multi Center Study

Abstract Background In March 2020, WHO has declared pandemic on COVID-19. Although the number of infected cases is increasing, information about its clinical characteristics in the Middle East especially in Iran, a country which is considered as one of the most important foci of the disease in the world is lacking. Till date, there is no available literature on the clinical data on COVID-19 patients in Iran. Method and Material: In this multicenter retrospectively registered study, 113 hospitalized confirmed cases of COVID-19 admitted in university affiliated hospitals in Shiraz, Iran in from February 20 to March 20 were enrolled. Results The median age was 53 years and 71 (62.8%) were males. The most common symptoms at onset were fatigue (75: 66.4%), cough (73: 64.6%), and fever (67: 59.3%). Laboratory data revealed significant correlation between lymphocyte count, partial thromboplastin time, international normalized ratio with the severity of the disease (P value = 0.003, 0.000, 0.000, respectively). The most common abnormality in chest CT scan was ground-glass opacity (77: 93.9%), followed by consolidation (48: 58.5%). Our results revealed an overall 8% (9 out of 113 cases) mortality rate among the patients, in which the majority was among the ICU admitted patients (5: 55.6%). Also, 68 (60.2%) of our patients achieved total recovery and 7 (6.2%) were discharged with follow-up and home isolation. Conclusion In this multi-center study which included 113 hospitalized patients with diagnosis of COVID-19, 9.7% of cases were transferred to ICU and mortality rate was 8%. Furthermore, finding the source of infection and studying the behavior of COVID-19 is crucial for understanding the pandemic.

scholarly journals CORRELATION BETWEEN SERUM C-REACTIVE PROTEIN LEVEL WITH SEVERITY OF THE DISEASE IN COVID-19 PATIENTS

2021 ◽  
Vol 5 (11) ◽  
Author(s):  
Sangeeta Gahlot ◽  
Surendra Yadav ◽  
Makkhan Lal Saini
Keyword(s):  
Severe Disease ◽  
Serum Levels ◽  
Cross Sectional Study ◽  
P Value ◽  
C Reactive Protein ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Group I ◽  
Moderate Disease ◽  
Severity Of The Disease

Background: To find the levels of serum CRP in confirmed Covid-19 patients and to compare their levels in patients with mild to moderate disease and patients with severe disease who required ICU care for management. Methods: A Cross sectional study was carried out on 100 confirmed cases of Covid-19, in whom Serum levels of Random sugar (RBS), Creatinine, Urea, C- reactive protein (CRP) were measured. Results: The levels of serum Urea, Creatinine were significantly increased in group II when compared to group 1, and the levels of CRP were significantly increased with p value <0.0001 in group IIwhen compared to group I. Conclusion: Findings of our study suggest that determination of biochemical parameters like CRP at the time of hospitalization helps in predicting the severity of disease and need for ICU for better treatment management and prevention of adverse outcome. Keywords: Severe acute respiratory syndrome, Covid-19, C- reactive protein, Intensive care unit.

scholarly journals Analysis of clinical characteristics of SARS-CoV-2 infected cases: a retrospective study of medical records

2020 ◽  
Author(s):  
Han Zhang ◽  
Lian Lu ◽  
Wei Hu ◽  
Jian Zhang ◽  
Wei Zhu ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Clinical Characteristics ◽  
Virus Disease ◽  
Laboratory Data ◽  
Organ Damage ◽  
Multiple Organ ◽  
P Value ◽  
Data Types ◽  
Nucleic Acid Test ◽  
Acid Test

Abstract Objectives In order to identify the clinical characteristics of patients with Corona Virus Disease 2019 (COVID-19) and find out the characteristic effects of 2019 New Coronavirus (SARS-CoV-2) infection on changes in clinical and laboratory data. Patients and methods From January 22 to February 13, 2020, we enrolled consecutive patients with acute respiratory tract symptoms admitted to a hospital (Ezhou, Hubei, China). For different data types t-test, the variables associated with the diagnosis of COVID-19 were compared by chi-square test and u-test, the statistically significant variables (P-value<0.05) were selected into the final logistic regression model. Results 62 (77.5%) confirmed cases and 18 (22.5%) negative cases were confirmed by SARS-CoV-2 nucleic acid test. Epidemiological investigation and statistical analysis were carried out on the clinical and laboratory data of all suspected cases of COVID-19, the specific indicators were found, and the clinical characteristics of COVID-19 were described. Compared with the patients with negative nucleic acid test, the patients with positive nucleic acid test showed shorter time of onset of symptoms, higher plasma CO2 level, lower eosinophil ratio, lower platelet count and hematocrit, lower serum sodium level, higher serum creatinine, higher blood urea and plasma albumin levels (all P<0.05). Conclusions we argue that the SARS-CoV-2 infection can cause multiple organ damage to the heart, liver, kidney and bone marrow other than lung injury.

scholarly journals COVID-19 among Minority Children in Detroit, Michigan during the Early National Surge of the Pandemic

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110227
Author(s):  
Jocelyn Y. Ang ◽  
Nirupama Kannikeswaran ◽  
Katherine Parker ◽  
Eric McGrath ◽  
Nahed Abdel-Haq ◽  
...  
Keyword(s):  
Disease Severity ◽  
Care Center ◽  
Severe Disease ◽  
Tertiary Care ◽  
Hospitalization Rate ◽  
Severe Illness ◽  
P Value ◽  
Antibody Testing ◽  
Igg Antibody ◽  
Increased Risk

Background. The COVID-19 pandemic has shed light on communities of racial/ethnic minority groups in the US where long-standing health issues and structural inequities are now known to have resulted in increased risk for infection, severe illness, and death from the virus. The objective of our study was to describe demographic characteristics, clinical presentations, medical interventions and outcomes of pediatric patients with COVID-19 treated at Children’s Hospital of Michigan (CHM), a tertiary care center in urban Detroit, an early hotspot during the initial surge of the SARS-CoV-2 pandemic. Methods. A retrospective chart review was performed of children ≤18 years of age who had polymerase chain reaction (RT-PCR) testing via NP swab or serum IgG antibody testing for SARS-CoV-2 during March 1, 2020–June 30, 2020. Results. Seventy-eight COVID-19 infected children were identified of whom 85.8% (67/78) were from minority populations (African American, Hispanic). Hospitalization rate was 82% (64/78). About 44% (34/78) had an associated comorbidity with asthma and obesity being most common. Although all ages were affected, infants <1 year of age had the highest hospitalization rate (19/64, 30%). In all disease severity categories, dichotomized non-whites had more severe disease by percentage within race/ethnicity than Whites, and also within percent disease severity ( P-value = .197). Overall, 37% of hospitalized patients required intensive care. Conclusions. Extremely high rates of COVID-19 hospitalization and requirement of ICU care were identified in our patient population. Further studies are needed to better understand the contributing factors to this health disparity in disadvantaged communities.

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