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Background The medical community's understanding of the novel coronavirus disease (COVID-19) was limited initially, and many laboratory investigations were performed to observe effects of the virus on the body, its complications, and outcomes. We observed that some laboratory investigations provided redundant information regarding outcomes, and, therefore, were not necessary. Therefore, the extent of laboratory investigations may need to be pared down to not only avoid issues related to repeated blood sampling but also to minimize the financial burdens in poor socioeconomic countries. Objective This study aimed to observe trends of clinical and laboratory values in COVID-19 patients and their relationship to outcomes, including disease severity, length of hospital stay, and mortality. Methods We conducted an observational cohort study of COVID-19 patients treated as inpatients at the Shifa International Hospital (SIH) in Islamabad in April 2020. Patients were included if they were nonsurgical, adult inpatients of SIH diagnosed with COVID-19 via positive polymerase chain reaction test. We monitored study participants' clinical and laboratory values (including hypoxia) on admission and throughout the study period. We used IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA) for data entry and analysis. Descriptive statistics were calculated for qualitative and quantitative data. We determined the effect of all variables on outcomes through chi-squared or Fisher's exact test, and p-values <0.05 with 95% confidence interval were considered statistically significant. Results A total of 51 patients with COVID-19 were enrolled. Most of the study participants were men older than age 50 with multiple comorbidities and resided in Khyber Pakhtunkhwa. Length of hospital stay ranged from eight to 14 days, and most patients had severe disease and survived. Factors such as patient age, gender, comorbid conditions, residence, and medication did not significantly affect outcomes. Hypotension during the height of symptoms and oxygen saturations <80% on admission was associated with prolonged hospital stays. Two complete blood count (CBC) parameters (platelet counts and mean corpuscular volume, MCV) were strongly associated with mortality and severity in our patients. Four non-CBC parameters (alanine transaminase, ALT; D-dimer; C-reactive protein, CRP; and lactate dehydrogenase, LDH) had strong statistical impact on disease severity, length of hospital stay, and mortality in our patients. Conclusion In a resource-limited country, laboratory testing must be chosen wisely and used appropriately. Patient age, gender, comorbid conditions, drugs, residence, and ferritin levels did not affect COVID-19 outcomes. Hemoglobin, platelet count, MCV, CRP, D-dimer, ALT, LDH, hypoxia, and hypotension were all correlated to disease outcomes. Therefore, these factors are useful laboratory examinations for COVID-19 patients, especially in poor countries.
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PURPOSE: The aging population is predisposed to cardiovascular disease. Our goal was to determine the relationship between a higher Elder Risk Assessment (ERA) score and coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), in adults over 60 years. METHODS: This was a retrospective cohort study in a primary care internal medicine practice. Patients included community-dwelling individuals aged 60 years or older on January 1, 2005. The primary outcome was a combined outcome of CABG and PCI in 2 years. The secondary outcome was mortality 5 years after CABG or PCI. The primary predictor variable was the score on the ERA Index, an instrument that predicts emergency room visits and hospitalization. The outcomes were obtained using administrative data from electronic medical records. The analysis included logistic regression, with odds ratios for the primary outcome and time-to-event analysis for mortality. RESULTS: The records of 12,650 patients were studied. A total of 902 patients (7.1%) had either CABG or PCI, with an average age of 74.5 years (±8.3 years). There were 205 patients (23%) who experienced CABG or PCI in the highest-score group (top 10%) compared with 29 patients (3%) in the lowest score group, for an odds ratio of 15.4; 95% confidence interval, 10.1-23.5. There was a greater association of revascularization events by increasing score group. We noted increased mortality by increasing ERA score, in patients undergoing CABG or PCI. The patients in the highest-scoring group had a 50% 5-year survival rate compared with a 97% 5-year survival rate in the lowest-scoring group (P < 0.001). CONCLUSION: Older adults in the highest-ERA-scoring group had the highest utilization of CABG or PCI. Patients with high ERA scores undergoing coronary revascularization were also at the highest risk of mortality. Providers should be aware that higher ERA scores can potentially predict outcomes in high-risk patients.