Publication:

Assessment of clinical, biochemical and radiological profile of SARS COVID-19 patients in a tertiary healthcare hospital and subsequent prediction of prognostic indicators

Background To describe the clinical characteristics and outcomes of SARS COVID-19 patients in Karnataka state, India and to evaluate risk factors and laboratory abnormalities leading to adverse outcomes. Radiological chest x-ray features of patients were studied and further elaborated upon.

Methods A hospital-based, single centre observational prospective study was conducted which included 144 adults with confirmed cases of SARI as per the accepted definition admitted to Kasturba hospital, Manipal in a one-month time frame period who tested positive for the coronavirus. Symptoms taken into consideration were cough, sore throat, breathlessness, and fatigue commonly seen co-morbidities were diabetes, hypertension, IHD and chronic kidney disease. Laboratory variables taken were haemoglobin, CRP, urea, creatinine, NT-Pro BNP and LDH.  Final outcome measured was the need for mechanical ventilation which correlates to disease severity. Multivariate logistic regression analysis was done for NLR ratio. Also evaluated was the abnormal radiological appearance of affected patients on chest X-ray describing baseline status and distribution of infiltrates.

Results Median age of patients was 58 years, 69.4% males (100) and the remaining 30.6% females (44). The mean symptom duration before hospitalization was 3.5 days with a maximum of 30 days and minimum of 1 day. Breathlessness (52.8%) was most commonly seen symptom with almost half (50%) patients having pre-existing hypertension as a co-morbid condition. 46.5% patients had pre-existing diabetes. Abnormal lab values of parameters studied was shown to have a positive association with disease severity. Chi square statistics for decreased haemoglobin was 18.5363, urea-44.6823, creatinine-33.4771, NT PRO BNP-39.812, LDH- 81.3515, with p<0.00001 in all cases. An elevated NLR ratio was found in most patients requiring mechanical ventilation with a significant p<0.05. The 59.7% patients had bilateral lung involvement on CXR with 38.9% showing basal infiltration.

Conclusions Early detection of laboratory abnormalities in haemoglobin, urea, creatinine, NT pro BNP, LDH and NLR ratio were found to be efficacious in forecasting need for mechanical ventilation in COVID-19 patients and can help better predict patient outcomes to avoid delays in management and care.