Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

Prof. Somashekhar Nimbalkar

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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On Sep 2018

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On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : OC13 - OC17 Full Version

Predictors of Length of Hospital Stay in Patients with COVID-19: A Retrospective Study

Published: January 1, 2023 | DOI:
Sujata Jayant Khatal, Shilpa Shaunak Sule, Ajinkya Jayaji Pandhare, Yashodeep Ashokrao Girwalkar

1. Associate Professor, Department of Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Pune, Maharashtra, India. 2. Associate Professor, Department of Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Pune, Maharashtra, India. 3. Junior Resident, Department of Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Pune, Maharashtra, India. 4. Junior Resident, Department of Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Pune, Maharashtra, India.

Correspondence Address :
Dr. Sujata Jayant Khatal,
Sargam, B 705, Nanded City, Sinhgad Road, Pune-411041, Maharashtra, India.


Introduction: Known independent predictors of extended Length Of Stay (LOS) in Coronavirus Disease 2019 (COVID-19) included older age, chronic kidney disease, elevated maximum temperature, and low minimum oxygen saturation. Additional known predictors of prolonged hospitalisation included male sex, chronic obstructive pulmonary disease, hypertension, and diabetes. Elevated levels of C-Reactive Protein (CRP), creatinine, and ferritin are proven determinants of hospitalisation and LOS. Determining predictors of LOS will aid in triaging and management of COVID-19 patients.

Aim: To assess the clinical, biochemical and radiological profile of admitted COVID-19 patients and determine the predictors of prolonged length of stay at hospital.

Materials and Methods: It was a retrospective, cross-sectional observational, record-based study included hospital records of 544 confirmed COVID-19 patients, above age of 18 years admitted at Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India, during February 2021 to June 2021. Possible determinants of LOS were studied including their demographic, epidemiological, clinical and radiological characteristics. The patients were divided into two groups as per median LOS i.e, group I with LOS <10 days (n=277) and group II with LOS ≥10 days (n=267). Statistical analysis was done using Chi-square test, proportion test, Z test, Mann-Whitney U test, regression analysis by Statistical Package for the Social Sciences (SPSS) software version 23.0.

Results: Mean age in group I and II was 47.83±16.34 years and 53.21±15.63 years (p-value <0.0001), respectively. The fatigue was significantly more in group II than group I (p-value=0.018). Diabetes mellitus was more (p-value=0.026) and severity of illness (p-value <0.0001) was significantly higher in group II than group I. In univariate analysis, mean Neutrophil/Lymphocyte ratio (p-value <0.0001), serum LDH (p-value <0.018), blood urea level (p-value <0.0001), random blood sugar (p-value=0.003), glycated haemoglobin (HbA1c) (p-value=0.072) and serum creatinine (p-value=0.41) were significantly more in group II. Median CRP (p-value <0.0001), D-dimer (p-value <0.0001), serum ferritin (p-value <0.0001), procalcitonin (p-value <0.0001), Serum Glutamic Oxaloacetic Transaminase (SGOT) (p-value=0.002) was significantly higher in group II. Lung involvement {chest radiograph or High-Resolution Computed Tomography (HRCT) chest} was significantly (p-value <0.0001) more in group II.

Conclusion: Fatigue, older age, diabetes mellitus, severity of illness, mean neutrophil/lymphocyte ratio, CRP, D-dimer, serum ferritin, serum Lactate Dehydrogenase (LDH), procalcitonin, blood urea, SGOT were associated with prolonged LOS among hospitalised COVID-19 patients.


Coronavirus disease 2019, C-reactive protein, Diabetes, D-dimer, Fatigue

During Coronavirus Disease 2019 (COVID-19) pandemic healthcare almost collapsed in developed as well as developing countries. A large number medical and paramedical staff, along with a huge number of hospital beds were required to treat confirmed COVID-19 cases. This led to overburdening and exhaustion of healthcare systems all over world.

Advanced age (1), male sex, fever, chronic kidney disease or liver disease before admission and increasing creatinine levels are some of the known factors for prolonged Length Of Stay (LOS) (2). Diabetes (3), raised inflammatory markers like C-Reactive Protein (CRP), D-dimer, Lactate Dehydrogenase (LDH) (1) are also some of the known factors associated with prolonged length of stay. So, it is important to know predictors of length of hospital stay in hospitalised COVID-19 cases. Determining risk factors on admission, to predict length of hospital stay, can help treating physician for triaging the patients and to monitor vulnerable patients more closely and will be helpful for manpower management also. This will consequently reduce cost, complications and mortality.

Average hospital stay for admitted COVID-19 cases varies across countries. For instance, meta-analysis on 52 studies revealed the average time of hospital stay from China was 14 days and 5 days outside of China (4). A study from Patna, India found that presence of breathlessness at admission, co-morbidities, Chronic Obstructive Pulmonary Disease (COPD)/asthma, deranged diastolic blood pressure, and higher quick Sequential Organ Failure Assessment (qSOFA) score at admission were associated with greater duration of hospitalisation (5).

Projecting future demand requires an estimate of, length of hospital stay at different care levels required by patients with COVID-19. A study done in Greece, involving type 2 diabetic patients showed that hospitalisation was significantly prolonged in patients with glucose>180 mg/dL than those with lower levels on admission (6).

A study from Cisanello hospital of Pisa, Italy showed subjects with obesity with COVID-19 require prolonged hospitalisation (7). A study done in Sichuan Province of China, found that patients ≥45 years old, having severe illness, living in areas with fewer healthcare workers per 1000 people and being admitted to higher grade hospital had longer LOS (8). Another study from Hefei, China found female gender, presence of fever on admission, pre-existing Chronic Kidney Disease (CKD) or liver disease to prolong hospital stay (2). A study from New York, showed that age, CKD, temperature, oxygen saturation, elevated levels of CRP, creatinine, and ferritin was associated with prolonged LOS (9).

India has seen 28, 173, 655 cases till 31st May 2021. Among Indian patients highest number of cases during second COVID-19 wave were recorded in Maharashtra with a 20.3% share of all Indian cases as of 31st May 2021. In Maharashtra, the Pune city had a huge number of cases with shortage of beds. From March 2020 to 31st May 2021 Pune District was worst affected with 10, 17, 154 cases and 12, 507 fatalities (10).

There are many studies on predictors of prolonged LOS from outside India but Indian studies and data on the same are lacking, hence, this study was conducted.The aim of the present study was to study the clinical, biochemical and radiological profile of admitted COVID-19 patients and to determine the predictors of prolonged length of stay at hospital.

Material and Methods

The retrospective observational study was conducted at Bharati hospital and Medical College, Pune, Maharashtra. Data belonging from the period February 2021 to June 2021 was collected. The analysis and interpretation was done from March 2022 to May 2022. This study was approved by ethics committee of Bharati Vidyapeeth (deemed to be university) Medical College and Hospital (ref: BVDUMC/IEC/20B, Dt.25/04/2022).

Inclusion criteria: All patients with confirmed COVID-19 above 18 years of age admitted to COVID-19 wards.

Exclusion criteria: Patient staying in hospital for lack of facility for isolation (as mentioned in discharge records).

A total of 544 records were retrieved. Discharge and admission criteria were applied as per guidelines of Maharashtra’s COVID-19 task force (11).

Admission criteria

These were as follows:
1. Age >60 years, diabetes mellitus, hypertension/ischaemic heart disease, COPD/chronic lung disease, immunocompromised state, immunosuppressive drugs, chronic kidney disease, obesity, chronic liver disease.
2. Symptomatic patients with any of the following signs (irrespective of co-morbidity)- Fever >100.4° F, respiratory rate >22/min, Systolic Blood Pressure (SBP) ≤100 mmHg, respiratory distress, cyanosis, change in mental state.

Discharge criteria

These were as follows:
1. Mild disease- No fever for three days.
2. Moderate disease- Fever resolved within three days and oxygen saturation maintained without support for consecutive three days.
3. Severe disease- Discharge only after clinical recovery, patient tested negative once by Reverse Transcription-Polymerase Chain (RT-PCR).

Categorisation of patients was done as per the following clinical staging system (11)-

1. Mild- Mild/early infection.
2. Moderate- Pulmonary involvement without hypoxia.
3. Severe- Pulmonary involvement with hypoxia with sepsis/shock/multiorgan dysfunction syndrome.

Study Procedure

Epidemiological, demographic, clinical and laboratory data for each patient were extracted from the medical record section as per predesigned proforma. Symptoms on admission and other parameters on admission were recorded. The records during admission were checked for complete blood count, random blood sugar level, liver function test, kidney function test, C-reactive protein level, D-dimer, procalcitonin, LDH, serum ferittin, Glycated haemoglobin (HbA1c). All patients had undergone either chest radiograph or High-Resolution Computed Tomography (HRCT) chest.

There are no definite guidelines defining prolonged LOS among hospitalised COVID-19 patients. Hence, stay of more than 10 days was taken as prolonged LOS depending on the median LOS in this study, which was 10 days.

Group I: Length of stay <10 days and
Group II: LOS ≥10 days.

Statistical Analysis

Statistical analysis was done using Chi-square test, proportion test, Z test, Mann–Whitney U test, regression analysis by Statistical Package for Social Sciences (SPSS) software version 23.0.


The present study included 544 patients. The characteristics of patients are listed in (Table/Fig 1).The mean age of patients was 47.83 vs 53.21 for group I and II (p-value <0.0001), respectively. There were more males in the group II (176, 65.92%). Among all patients, the most common symptoms on admission were fever, cough and shortness of breath followed by fatigue, myalgia and sore throat. Co-morbidities were present in almost 60% of patients with hypertension (69.24%) and diabetes (64.5%) being the most common co-morbidity. Clinical symptoms on admission showed no significant association with LOS. Only patients with loss of smell had LOS ≥10 days, (p=0.05). Out of total 544 patients, 277 patients had length of stay <10 days and remaining 267 patients had LOS ≥10 days. Mean age was significantly more in the group with LOS ≥10 days. Fatigue was significantly more in LOS ≥10 days; fever, cough, shortness of breath, nausea/vomiting, sore throat, myalgia, headache, loss of taste, diarrhea, runny nose, hemoptysis were observed almost equally in both the groups. DM and severity of illness was significantly more in LOS ≥10 days than LOS <10 days (Table/Fig 1).

In the univariable analysis, fatigue, diabetes mellitus and severity of illness were significantly associated with prolonged LOS. Loss of smell and bronchial asthma/COPD were associated with prolonged LOS but the association was not significant (Table/Fig 2).

Mean N/L, WBC, LDH, BUL, serum creatinine, random blood sugar, HbA1c was significantly more in LOS ≥10 days than LOS <10 days (p-value <0.0001). Median CRP, D-dimer, serum ferritin, procalcitonin, Serum Glutamic Oxaloacetic Transaminase (SGOT), Serum Glutamic Pyruvic Transaminase (SGPT) was significantly more in LOS ≥10 days than LOS <10 days. Chest X-ray or Computed Tomography (CT) findings were significantly associated with prolonged LOS (Table/Fig 3).

In the univariate analysis, N/L ratio, CRP, D-dimer, serum ferritin, LDH, procalcitonin, BUL, random blood sugar, SGOT were significantly associated with prolonged LOS (Table/Fig 4).


The study aimed to determine all factors for prolonged length of stay and all patients were discharged as per guidelines advocated at that time as per Maharashtra’s COVID-19 Task Force policy.

The (Table/Fig 5) showed variation of median length of stay and factors associated with prolonged LOS at various places of different countries, the stay more than median length of stay was considered prolonged. In the present study, the average age of patients with a prolonged LOS was higher than that of patients with normal LOS, (47.83±16.34) vs. (52.21±15.63) which was statistically significant.In a study by Grasselli G et al., among admissions of COVID-19 patients in ICU, majority were older men (19). A retrospective study in Vietnam showed age and residence were significantly associated with longer duration of hospitalisation in patients with COVID-19 during second wave (16). Hassan Alwafi H et al., in their study found that age has significant impact on LOS (1). Fever (76.84% vs. 76.4%), cough (73.65% vs. 76.4%), shortness of breath (57% vs. 58%) were most common symptoms, observed in this study in LOS <10 days vs. LOS ≥10 days, but were not statistically significant. In some studies, high fever was associated with severe COVID illness and ARDS (20). Wu S et al., also found that having fever before admission was associated with increased LOS (17). However, in this study, fatigue instead of fever, was most common symptom associated with increased LOS and was statistically significant. In this study of COVID-19, patients with prolonged LOS presented with shortness of breath (58.27%), fever (76.40%), cough (76.40%), but haemoptysis was less common. It was found in only 1 to 2% of all patients, which was similar to study of Tang X et al., (21). In this study males (63.78%) were affected more than females (36.21%). Like many other studies males had prolonged LOS (65.92%) than females (34.08%) though not statistically significant. The possible explanation for more infection in males is, they are more susceptible to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection than females (22). The gene responsible for ACE2 expression lies in the X chromosome.The females have two copies and thereby double the amount of Angiotensin-Converting Enzyme 2 (ACE2), which may compensate for SARS-CoV-2 mediated down regulation of ACE2 cell surface expression (23). Bai F et al., found that female gender is associated with long COVID-19 syndrome (24). Epidemiological data from many studies confirms more severe disease in males (25).

Presence of DM was significantly more in LOS ≥10 days (36.70%) than LOS<10 days (27.80%), and was statistically significant, which was similar to study of Alkundi A et al., and Alahmari AK et al., (26),(27). Hypertension (37% versus 31%), IHD (17% versus 13%), CKD (11% versus 6%), bronchial asthma (6% versus 1%) were more in LOS ≥10 days but not statistically significant. Wu S et al., found that DM was associated with prolonged LOS (17).

In the study by Alwafi H et al., D-dimer >0.5, white blood cells >10,000, CRP >0.3 mg/dL, LDH >230 U/dL were associated with increased LOS (1). In this study, by univariable analysis, high Neutrophil-Lymphocyte ratio, CRP, D-dimer, serum ferritin, LDH, procalcitonin, BUL, random blood sugar, SGOT were significantly associated with prolonged LOS.

The leucocyte count increment, decreases hospital length of stay by 0.95 among COVID-19 patients. Studies showed that leucocytosis is a biomarker of COVID-19 severity clinical stages (28),(29),(30). This could be indirectly because increment of leucocyte, aggravates the clinical outcome of the patient that results in shortening of length of stay by ending up the stay with death. In contrast this study showed leucocytosis was statistically significantly associated with prolonged LOS.

In the present study, increase in BUN was significantly associated with prolonged LOS.The study by Qu J et al., suggests BUN could be independent factor for predicting the severity of COVID-19 (31). BUN is one of the indices that may predict the patients at high risk of in-hospital mortality. This finding can be justified by the fact that increment of serum BUN predicts the severe clinical stages which may result the shortening of patient’s hospital stay due to death. In contrast, in this study increased BUN was associated with prolonged LOS.

Liu X et al., found lymphopenia as a marker for prolonged length of stay (15). In the present study increased N/L ratio was statistically significantly more in LOS ≥10 days vs LOS <10 days (5.22 versus 4.21). This may be related to more severity of illness, which was similar to findings of Ghaharamani S et al., (32). and Gayatri T et al., (14). The disease severity was associated with prolonged LOS and was statistically significant (p-value <0.0001). In contrast Guo A et al., found that a longer LOS was associated with milder disease (2).

High CRP and LDH levels have been previously associated with a severe clinical course and prolonged hospitalisation (30). Buyukaydin B, found that CRP, LDH, ferritin at the time of hospitalisation were among the other factors affecting LOS (33). Chest radiograph findings of consolidation were significantly more in LOS ≥10 days than LOS <10 days.


It is a retrospective study with small sample size, done at one centre.LOS may vary due to difference in admission and discharge criteria at various COVID-19 centres.


The COVID-19 pandemic continues to affect the world with increasing cases and mortality. In the present study predictors of length of stay in COVID-19 were determined. Factors like fatigue, older age, diabetes mellitus, severity of illness, neutrophil/lymphocyte ratio, CRP, D-dimer, serum ferritin, serum LDH, procalcitonin, random blood sugar, blood urea level, SGOT are some of the factors associated with prolonged length of stay among hospitalised COVID-19 patients. Future studies are needed to confirm the above factors for their association with prolonged length of stay.


Authors would like to express heartfelt gratitude to Dr. Supriya Barsode, Head of Department of Medicine, all patients and statistician for their support.


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DOI and Others

DOI: 10.7860/JCDR/2023/60514.17314

Date of Submission: Oct 17, 2022
Date of Peer Review: Nov 15, 2022
Date of Acceptance: Dec 13, 2022
Date of Publishing: Jan 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No

• Plagiarism X-checker: Oct 19, 2022
• Manual Googling: Nov 30, 2022
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