Background: The clinical profile and outcomes of severe COVID-19 vary across regions and health-care settings. We evaluated the clinico-demographic characteristics and in-hospital outcomes of patients with severe COVID-19 pneumonia admitted to a tertiary hospital in North India. Methods: We performed a prospective observational study of RT-PCR–confirmed COVID-19 patients meeting severity criteria (respiratory rate >24/min, SpO₂ <94% on room air, or organ dysfunction) over seven months. Demographics, symptoms, comorbidities, laboratory tests, and HRCT findings were recorded. Outcomes included in-hospital mortality. Results: Of 179 severe cases, 95 were men (53.1%) and 100 were from rural areas (55.9%). Fever was the most common symptom, followed by cough and breathlessness; universal hypoxaemia was documented on admission. Tachycardia occurred in 89.4%, tachypnoea in 50.3%, bradycardia in 7.3%, and hypotension in 1.7%. Hypertension (48.0%) and diabetes (9.5%) were the leading co-morbidities; one-third had none. Lymphopenia was seen in 19.0% and leukocytosis in 11.2%; HRCT showed a CT severity index >6 in all patients. Overall mortality was 13.4% (24/179) and was higher in males (62.5% of deaths), in those ≥60 years (58.3%), with comorbidities (66.7%), and from rural areas (75%). Conclusion: Severe COVID-19 pneumonia at our centre was characterised by fever with hypoxaemia, frequent hypertension and lymphopenia, and a moderate fatality rate. Male sex, older age, rural residence, co-morbidities, lower SpO₂, and higher CT severity were associated with death, underscoring the need for early risk stratification and intensified management in these subgroups.
On December 8, 2019, a case of pneumonia of unknown etiology was detected in Wuhan city, Hubei province, China1. On December 31, China reported a cluster of Pneumonia with unknown etiology to the World Health Organization (WHO), and seven days later, Chinese scientists identified the pathogen as a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 The WHO declared the outbreak a pandemic on 11 March 2020, due to the increasing number of cases outside China2. The pandemic is spreading exponentially, with millions of people across the globe at risk of contracting coronavirus disease 2019 (COVID-19). Coronavirus has caused large respiratory outbreaks previously in the form of severe acute respiratory syndrome (SARS) outbreak in 2003 and Middle East respiratory syndrome (MERS) in 2012 which has caused >10,000 cases globally and mortality around 10 and 37 per cent for SARS and MERS, respectively3,4. In India, the first case of COVID-19 was identified on January 30, 20205 and the number has been increasing steadily due to local transmission and foci of community transmission.
The study was conducted in a tertiary care hospital of north India to assess the clinico-demographic characteristic and outcome in RTPCR proven cases of severe COVID19 pneumonia. It was a prospective observational study. A focused history including travel and exposure history and comorbidities were recorded. After initial clinical evaluation, patients with dyspnea, respiratory rate (RR) >20/min, or oxygen saturation (SpO2) <94 per cent on room air, clinical diagnosis of pneumonia and those deemed to be at risk for severe disease were subjected to chest radiography. Baseline haemogram, liver and kidney function tests were done for all symptomatic patients. Patients with age >60 years and those with cardiovascular risk factors, immunocompromised state and chronic diseases, were considered at high-risk for progression to severe disease. Severe disease was defined a patient with RR >24/min, SpO2 <94 per cent on room air, confusion, drowsiness, hypotension, sepsis, septic shock or admission to ICU.
Total 179 patients of clinically or radiologically documented severe COVID19 pneumonia were included in study of which 95 were males (53.07%) 84 (46.92%) females 100 (55.86%) patients were from rural area 79 (44.13%) urban area. most common presenting symptom was fever (n=120) followed by cough and breathlessness (n=80) other were myalgia, loose motion, loss of taste and smell the most common sign was hypoxemia (n=179) tachycardia (n=160) tachypnea (n=90) bradycardia (n=13) and hypotension in 3 patients. Most common comorbidity was hypertension 86 (48.04%) followed by diabetes mellitus 17 (9.49%) other were CAD (n=5), COPD (n=3), asthma (n=2), malignancy (n=2), seizure disorder (n=2), active tuberculosis (n=1) and CKD (n=1) whereas 60 (33.51%) were having no underlying comorbidities. Most common CBC abnormality was leukopenia particularly lymphopenia 34 (18.99%) leukocytosis 20 (11.17%) whereas 125 (69.83%) had normal CBC HRTCT revealed CTSI more than 6 in all 179 patients. Out of 179 patients 24 (13.40%) patients expired death were more common in males 15 (62.5%) than females 9 (37.5) elderly 14 (58.33%) were more than 60 years and patients with underlying comorbidities 16 (66.66%) rural 18 (75%) than urban.
In this prospective cohort of 179 patients with severe COVID-19 pneumonia from a North Indian tertiary centre, fever with hypoxaemia was the dominant presentation and hypertension was the commonest co-morbidity. Overall in-hospital mortality was 13.4% and was significantly concentrated among men, older adults (≥60 years), patients from rural areas, and those with underlying co-morbidities. Lymphopenia and high HRCT severity (CTSI >6 in all) were frequent among severe cases. Early recognition of hypoxaemia, aggressive monitoring of high-risk groups, and timely referral of rural patients may reduce adverse outcomes.
Funding: none.
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