Assessment of risk factors in corona virus 19 infected persons

DISCUSSION

In this study, the commonest comorbid conditions were systemic hypertension 62 patients (62%), DM 61 patients (61%), and IHD 48 patients (48%).

 As a result of the quick increase in crucially ill patients and restricted health resources during the pandemic of COVID 19, in particular ICU beds and ventilation systems, efficient triage techniques for detecting patients at the highest risk of the worst outcomes are required to ensure an efficient allocation of resources for both outpatients and inpatients .⁵

According to our findings, older age and a SpO2 of less than 74% were important indicators of invasive respiratory assistance and in-hospital mortality during the present outbreak. In two earlier identical investigations, older age was proven to be one of the independent diagnostic variables for mortality in verified COVID-19 pneumonia cases.⁶

In an initial study of 121 patients admitted to an intensive care unit in the United States, eighty percent of those who died were 65 or older. ⁷ Comorbidities, particularly CVS and chronic respiratory diseases, are more prevalent among the elderly. In elderly people, several comorbidities may play a role in the development of ARDS and severe pneumonia.⁸

 Our study results exhibited that advanced age was accompanied by higher risk of infection with COVID-19, as concluded by Zhou et al. (2020a). For infections like SARS and MERS, advanced age has been determined to be a crucial indicator of fatality. ^{9, 10}

Myalgia (22%), chest pain, and DCL symptoms (atypical presentation,11 percent) were among the symptoms that were more frequent in the first group, according to our findings. It's possible that the start and persistence of symptoms indicate a poor prognosis. Non-survivors had a shorter time from disease beginning to admission and mortality, implying a faster disease progression.

In admitted cases, reduced blood O2 saturation has been used to determine the severity of COVID-19 pneumonia. SpO2 had previously been shown to be an important predictive method in community-acquired pneumonia, with a higher specificity for negative outcomes.^11,12

Also, GGO observed in the CT chest was proved to be one of the frequent results in COVID-19 pneumonia, with 100% of diagnosed cases validated by RT-PCR having such a result in an Italian investigation of 58 patients. The authors demonstrated that none of the CT criteria (GGO, pneumonia distributed bilaterally, involvement in ˃ 2 lobes, consolidation, as well as lymphadenopathy) were considerably distinct between COVID-19 cases that needed hospitalization versus those who were discharged for home isolation .¹³

In this research, a statistically significant difference between both groups was observed. These outcomes were in harmony with the outcomes obtained in the previous studies.

Our study agrees with those of another study that comprised 73 COVID-19 patients, 25 of whom had severe or critical conditions, and employed a CT scoring system in which elevated scores were correlated with greater severity of the disease .¹⁴

Reduced lymphocyte count was postulated to be an independent risk factor for in-hospital mortality in the multivariable logistic regression assay, and additional investigation demonstrated that lymphocyte count was a crucial predictor in the prediction of COVID-19 pneumonia in-hospital mortality detected via the ROC assay. Prior research found that lymphopenia represented a risk factor for higher SARS and COVID-19 fatality rates.¹⁵ Adults with critically ill SARS have short-term outcomes as well as risk factors for death.¹⁶

In our study, we agree with the previous studies as statistically significant differences between the 2 examined groups were determined in regards to more lymphopenia in the 1^st group.

Another study found that the percentage of lymphocytes (LYM) [percent] was an important predictor of the severity of COVID-19. ¹⁷

The decreased LYM (%) could be attributed to the fact that coronavirus can cause lymphocyte damage during the acute process. The reduced LYM% might indicate that the immune system is under-activated and/or over-exhausted, rendering it unable to contain COVID-19 infection. ¹⁸

According to prior research, ~90% of cases with severe pneumonia exhibited higher coagulation activity, as denoted by a high D-dimer concentration. ¹⁹

Increased D-dimer levels were shown to be associated with elevated fatality rates in emergency room cases of sepsis. ²⁰

In addition, a prior study revealed that D-dimer ˃1 µg/ml was accompanied by deadly COVID-19 outcomes. ¹⁵

In this research, D-dimer has also been determined as an independent risk factor (P value 0.034) for in-hospital death.

Increased CRP on admission in cases with risk was accompanied by higher risk of mortality. CRP in the 1^st group with Mean ± SD. 82.42 ± 71.69 was elevated when compared to the 2^nd group with Mean ± SD 45.24 ± 23.05. We are in accordance with earlier studies that revealed a positive association of CRP level with the lung lesions as well as the severity of illness. Sahu et al demonestrated higher CRP concentration in cases died due to COVID-19 infections in comparison with survivors. Positive CRP was considered a predictor in Ruan   study ^{21.- 24}

 In a cohort study, SARS-CoV-2 infections were associated with a higher morbidity rate, which was consistent with earlier research.^25-30  Noteworthy, AKI was the commonest complication. Grasselli et al. revealed that AKI occurred in ~ 55% of 3988 consecutive severely sick patients with proven COVID-19 from an Italian Intensive Care Unit in Lombardy. The exhaustion of healthcare resources, combined with the relatively higher admission rate during the period of this research, might explain the relatively increased mortality and morbidity rates in comparison to following cohorts.^{27, 31}

Previous studies have shown that increased serum Cr is associated with frequent COVID-19 cases. Increased serum Cr on admission might denote the initial stages of renal destruction and easy progression to AKI. Early intervention in cases having increased serum Cr on admission that might occur prior to the occurrence of clinical manifestations of renal failure may produce better outcomes when compared to treatment of only established AKI cases. ³²

In this study in serum Cr in the first group is 2.38 ± 1.48, whereas in the second group is 1.21 ± 0.99 with while p value

CONCLUSION

Advanced age was more liable for COVID-19 infection.

Patients suffering COVID-19 infection in conjunction with risk factors had poor outcome when compared to others without.

 Systemic hypertension, DM, and IHD were independently accompanied by a greater risk of in-hospital mortality.

A statistically significant difference was detected in terms of more lymphopenia and increased inflammatory parameters in the first group.

The severity of COVID-19 pneumonia in hospitalized patients has been determined by reduced blood O2 saturation.