Impact of Co-morbidities on Outcome of COVID-19 Patients: An Observational Study among Patients Admitted to Intensive Care Unit
Faculty Residential Apartments, Dr Ram Manohar Lohia Institute of Medical Sciences, Vibhutikhand, Gomti Nagar, Lucknow, Uttar Pradesh, India.
Introduction: Coronavirus Disease-2019 (COVID-19) has been a major cause of apprehension, morbidity, and mortality in 2020. It had been postulated that associated co-morbid conditions in COVID-19 patients increase the severity of COVID-19 which leads to six times more chances of hospitalisation than patients without co-morbid condition. Mortality is also 12 times higher in such patients.
Aim: To find out the association between co-morbidities and mortalities due to COVID-19 pneumonia.
Materials and Methods: A prospective, observational study was conducted in a tertiary teaching institute of North India which was designated Level 3 (L-3) facility for treatment of COVID-19 patients. All 109 COVID-19 patients confirmed by Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR), admitted in Intensive Care Unit (ICU) from 1st July 2020 to 30th November 2020 formed the sample of the study. Data was taken regarding past history, clinical histories and examinations and ICU care and treatments. Based on their final outcome at the end of ICU care, patients were divided into two groups-group 1 (Non-survivor or Expired) and group 2 (Survived) and intergroup differences were studied.
Results: COVID-19 infection was about three times more common in males. Severe category of COVID-19 patients had higher mortality (59.2% of severe category expired during hospital course, 1.7% patients expired in moderate category group). Most common co-morbidities were hypertension (n=51, 46.8%) and diabetes (n=48, 44%). Multivariate analysis showed that co-morbidities in the form of chronic liver disease (OR -0.127 (0.024-0.681, p-value 0.016)) and post tubercular sequel (OR 0.036 (0.003-0.442, p-value 0.009)) were less likely to occur in COVID-19 patients who survived, thus making these co-morbidities significant contributor to the adverse outcomes in COVID-19 patients. More number of co-morbidities in a patient were associated with higher chance of mortality and this trend was significant statistically (p-value <0.001).
Conclusion: Patients with multiple co-morbidities, chronic liver disease and post tubercular sequel were associated with higher mortality in COVID-19 patients.