ABSTRACT
Objectives: The aim of this study was to determine the predictors of mortality and describe laboratory trends among adults with confirmed COVID-19. Methods: The medical records of adult patients admitted to a referral hospital with COVID-19 were retrospectively reviewed. Demographic and clinical characteristics, and laboratory parameters, were compared between survivors and non-survivors. Predictors of mortality were determined by multivariate analysis. Mean laboratory values were plotted across illness duration. Results: Of 1215 patients, 203 (16.7%) had mild, 488 (40.2%) moderate, 183 (15.1%) severe, and 341 (28.1%) critical COVID-19 on admission. In-hospital mortality was 18.2% (0% mild, 6.1% moderate, 15.8% severe, 47.5% critical). Predictors of mortality were age ≥ 60 years, COPD, qSOFA score ≥ 2, WBC > 10 × 109/L, absolute lymphocyte count < 1000, neutrophil ≥ 70%, PaO2/FiO2 ratio ≤ 200, eGFR < 90 mL/min/1.73 m2, LDH > 600 U/L, and CRP > 12 mg/L. Non-survivors exhibited an increase in LDH and decreases in PaO2/FiO2 ratio and eGFR during the 2nd-3rd week of illness. Conclusion: The overall mortality rate was high. Predictors of mortality were similar to those of other reports globally. Marked inflammation and worsening pulmonary and renal function were evident among non-survivors by the 2nd-3rd week of illness.
ABSTRACT
Objectives: To describe the clinical profile and outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19) across the spectrum of disease severity. Methods: This retrospective study included adult patients with confirmed COVID-19 infection admitted to a referral hospital. Descriptive statistics, tests for trend, Kaplan-Meier curve and log-rank test were used to compare characteristics and outcomes across disease severity categories. Results: Of 1500 patients with COVID-19, 14.8% were asymptomatic, 13.5% had mild disease, 36.6% had moderate disease, 12.3% had severe disease and 22.7% had critical disease. Asymptomatic patients were admitted for a concurrent condition or for isolation. Patients aged >60 years, male gender and with co-morbidities had more severe disease. Fever, cough, shortness of breath, malaise, gastrointestinal symptoms and decreased sensorium were more common in patients with severe disease. Bilateral pulmonary infiltrates were common (51.1%), with sicker patients having more abnormal findings. The overall mortality rate was 15.1%. Adopting a symptom-based strategy reduced the length of hospitalization from a median of 13 [interquartile range (IQR) 7-21] days to 9 (IQR 5-14) days. Conclusion: The clinical profile and outcomes for this cohort of patients with COVID-19 was consistent with published reports. Asymptomatic infection was common, and universal testing may be a valuable strategy in the correct context, given the implications for infection control. A symptom-based strategy was found to reduce the length of hospitalization considerably.
ABSTRACT
PURPOSE: To describe the radiographic findings of hospitalized adult Filipino COVID-19 patients on serial chest x-ray imaging. METHOD: We performed a retrospective review of records and chest x-rays of eligible adult Filipinos with confirmed COVID-19 admitted from 1 March 2020 to 31 July 2020. Demographics, clinical outcomes, and chest radiographic findings were recorded. Serial chest x-ray findings were correlated with the clinical outcome. RESULTS: From 144 adult patients (93 males and 51 females), a total of 785 chest x-rays were reviewed (144 baseline and 641 follow-up). The most common finding overall is ground-glass opacity. The most common distribution pattern is bilateral, patchy/diffuse involvement of the central/peripheral zones. In x-rays taken after the third admission day, reticular opacities become more common than consolidation. The radiographic extent score was higher for deceased patients compared to the survivors at Day 7-9 (6 vs 4.4, p-value = 0.0011), Day 10-12 (5.9 vs 4.3, p-value = 0.0079) and Day 13-15 (5.5 vs 4.1, p-value = 0.0297). The presence of endotracheal tubes (68 % vs 7.5 %, p-value < 0.001) and pleural effusion (70 % vs. 36 %, p-value = 0.0004) were higher among the deceased. Reticular opacities were more common for discharged patients (50 % vs 30 %, p-value = 0.0021). CONCLUSION: Ground-glass opacities with bilateral, patchy/diffuse involvement of the central/peripheral zones are the most common findings. The presence of endotracheal intubation, pleural effusion, and persistently elevated radiographic extent scores are typically seen in deceased patients. Serial chest radiography with radiographic extent scoring is a useful tool in monitoring COVID-19 for hospitalized adult patients.
