Clinical profile and laboratory parameters in patients with moderate-severe COVID-19 pneumonia admitted in tertiary care hospital in South India

Introduction: Coronavirus pandemic has caused significant morbidity and mortality throughout the world Due to the novelty of this respiratory virus still, it is unclear regarding the clinical and laboratory profile of patients with COVID-19 pneumonia So, we took up the study to look for the clinical and laboratory profile of patients with moderate to severe COVID-19 infection Materials and methods: A retrospective study was conducted on moderate-severe COVID-19 pneumonia patients admitted to tertiary care hospitals from June to October 2020 Data included demographic details, symptoms, comorbidities, vital parameters were recorded Laboratory parameters included complete hemogram, neutrophil-lymphocyte ratio, serum ferritin, serum LDH, renal function test, liver function test, and arterial blood gas Treatments details like the use of remdesivir, use of steroids and anticoagulants, use of a high-flow nasal cannula, noninvasive ventilation, ventilator were collected Several ICU and hospital stay were recorded Results: 4012 confirmed cases of COVID-19 were admitted to hospital, of which 560(13 95%) patients who were of moderate-severe severity were included in the study Mean age of study population was 57 75 ± 13 96 years Three sixty five (65 17%) were men Hypertension (41 25%) was most common co-morbidity Dyspnea (69 46%) was the most common symptom followed by fever (52 5%) and cough (46 78%) Mean duration of symptoms before admission was 4 11 ± 2 09 days Mean Spo2 at admission was 78 70 ± 18 72 Mean neutrophil to lymphocyte ratio was 8 02 ± 8 66 Mean serum ferritin and serum Lactate dehydrogenase was 539 66 ± 381 78 and 845 73 ± 593 51 respectively Mean duration of symptoms before hospitalization was 4 11 ± 2 09 days Remdesivir was given to 298 (53 21%) patients Mean duration of starting Remdesivir after symptom onset was 5 58 ± 2 78 days Steroids were given to 454(81%) of patients and anticoagulation was given to 365(65 17%) of patients High flow nasal cannula was given to 245(43 7%) patients Ninety one (61 25%) were put on ventilator Mean duration of hospital stay was 8 71 ± 7 54 A very high mortality 306(54 64%) was observed at our hospital Discussions: During the course of this study, we found most of the patients with moderate to severe COVID-19 pneumonia were of an elderly population with male predominance A north Indian study found the majority of patients below 60 years of age with male predominance Another North Indian study also found a majority of patients below 60 years A retrospective study done in Wuhan found male predominance and elderly population affected with COVID-19 pneumonia similar to our study We found dyspnea to be the most common symptom at presentation In contrast, fever and cough were the most common symptom in a Chinese study and North Indian study 1-3 We found hypertension and diabetes to be the most common comorbidity similar to a Chinese study We found a high NLR ratio, high serum ferritin, and serum LDH in our study A Chinese study done on 110 patients found elevated procalcitonin and D-dimer in severe pneumonia patients A study was done in New York City also found elevated levels of C-reactive protein and D-dimer in patients with severe COVID-19 pneumonia We observed a mortality rate of around 54 64% at our hospital A systematic review done of mortality in patients admitted to ICU found a mortality rate of 37 7% in China, 25 6% in Italy, 23 6% in the US, 29 2% in Spain, 41 2% in Denmark Another small case series study in western India found a mortality rate of 16 7% in COVID ICU patients Conclusion: Patients who are elderly with comorbidities like diabetes and hypertension are more likely to have moderate to severe COVID-19 pneumonia requiring hospitalization Mostpatients had elevated serum LDH and serum ferritin which could be a reliable prognostic indicator Many patients presented late to the hospital with low oxygen saturation which has resulted in high mortality of 54 64% Early diagnosis and treatment may decrease mortality in COVID 19 patients