Analysis of mortality in COVID-19 patients admitted to an intensive care unit

Introduction: The COVID-19 pandemic has affected health care infrastructure worldwide In the city of Pune, we had multiple general and private hospitals admitting COVID positive patients Protocols and processes were set up as per the ICMR and local corporation guidelines There were many challenges to manage these patients especially with the newness of the disease, rapidity of spread, the uncertainty of progress of patients with respiratory failure, and lack of physical communication with relatives Challenges faced by the caregivers were manpower ratios possibly due to attrition and illness Here, we analyze the mortality of patients with COVID-19 infection admitted to a tertiary care center Objectives: Death audit of COVID positive patients who expired in the ICU from April to December 2020 - a 9-month retrospective data analysis Materials and methods: A retrospective observational analysis of deaths due to COVID-19 infection from March to December 2020 Results: 2012 COVID positive patients were admitted to a tertiary care for treatment of which 363 were either directly admitted or transferred into the ICU for moderate to severe/critical disease requiring NIRAD, IPPV or Organ support 164 patients expired of which 25 died within 24-48hours The gross hospital mortality from COVID19 disease was 8 17% while net mortality was 6 9% 107 (65 2%) patients died of severe COVID and 57 (34 75%) perished due to critical disease More males(76%) expired than females (24%) (n = 125 vs 39 ) Death was highest in age group >60 years with 31% (51) patients aged 61-70 years, 23% (38) patients aged 71-80 years 21% (35)expired between the age of 51- 60 years There was a child age 8years died of COVID 19 pneumonia with multisystem inflammatory syndrome of childhood 3 patients died age >90 years and 2 youngsters with IDDM ages 21 and 23 years died 8 ) in 34% of patients (56), hypertension in 39% (64), Ischaemic Heart disease in 19 5% (32), CKD IN 9 7% (16), Stroke old/recent in 6 7% (11) 3 patients had Chronic Liver diease and Parkinsons each, 2 had Alzheimers disease and I each suffered from multiple nyeloma, Carcinoma colon, cervical spine trauma, GBS, Ulcerative colitis 52 patients (31 7%) expired 20 days End of Life care consent was taken in 9 out of 164 patients who died (5 5%) High D dimers values >8 ng/dL at the time of death were seen in 39% (64) patients and a persistent low lymphocyte count <5% was seen in 93 3% of patients who expired Discussions: The COVID-19 pandemic has taken its toll on the health of the population, healthcare systems, and economic status of countries worldwide Due to variations in healthcare systems, demographics of the population and racial considerations different regions need to generate endogenous data It has been difficult to capture data due to high workloads Analyzing mortality would help us understand the robustness of the healthcare delivery system, demographic and racial variations, and predisposing risk factors to severe infection leading to death Ours is a 300-bedded tertiary care center in a smart city of India We treated 2012 patients infected with the SARS-CoV-2 virus Three hundred and sixty-three needed intensive care of which 164 expired The burden on the system increased through the months of July, August, September, and October when the peak of the pandemic was seen Seventy-five percent of the deaths occurred in these 4 months Large numbers of patients staying for 10 to 14 days, increased doctor, nurse to patient ratios due to caregiver burnout and illness may have also contributed to untoward outcomes Males were affected greater than females a d mortality was highest in patients aged between 60 and 70 years (31%) Fifty percent of patients died between 60 and 80 years of age which is comparable to western data Uncontrolled diabetes, hypertension, ischemic heart disease, and chronic kidney disease all of which cause endothelial dysfunction were the predominant risk factors predisposing to death in these patients End of life care consent was taken in 9 out of 164 patients who died (5 5%) Restriction of visitation and sudden onset of severe illness made it difficult for relatives to consent for end of life care High D-dimers and persistent low lymphocyte count at the time of death suggest these tests as predictors of mortality possibly due to persistent inflammation and microthrombosis and an inability to clear the virus or due to secondary sepsis as compared to CRP, troponin, LDH, creatinine, and albumin Conclusion: The COVID- 19 pandemic has tested the health infrastructure in all nations worldwide In the city of Pune, we had multiple general and private hospitals admitting COVID positive patients The net mortality rate in our hospital was 6 9% with more males perishing than females Infection in the elderly and uncontrolled diabetes were important risk factors for mortality as was hypertension High D-dimers and persistent low lymphocyte count at the time of death suggest these tests as predictors of mortality in our study