key: cord-0324652-59e3c19a authors: farooq, A.; Arsalan, R.; Aisha, M. K.; Muhammad, A.; Hayat, M.; Altaf, A.; Taqi, A.; Kumar, A.; Rehman, A.; Haidri, F. R.; Hussain, I.; Chaudhry, M.; Rehman, S.; Malik, I.; Saleem, J.; Ali, L.; Zia, M. A.; Khan, M. A.; Sheikh, M.; Ashraf, M. S.; Rana, M. A.; Khoso, M. N.; Rizvi, S.; Shaikh, N. A.; Salahuddin, N.; Khan, Q.-u.-A.; Sikander, R. I.; Ali, S. M.; Khan, R. N.; Babar, S.; Beane, A.; Dondorp, A. M.; Kodippily, C.; Priyadarshani, D.; Udayanga, I.; Ishani, P.; Darshana, S.; Rashan, T.; Haniffa, R.; Murthy, S.; Hashmi, M. title: PRICE COVID19 Data Report December 2021 Pakistan Registry of Intensive Care date: 2022-01-23 journal: nan DOI: 10.1101/2022.01.20.22269202 sha: 676794b15080ede65124c79ae91fc9d59f72fcc2 doc_id: 324652 cord_uid: 59e3c19a Abstract Pakistan Registry of Intensive Care (PRICE) is a platform that has enabled standardized COVID-19 clinical data collection based on ISARIC/WHO Clinical Characterization Protocol. The near real-time data platform includes epidemiology, severity of illness, microbiology, treatment and outcomes of patients admitted with suspected or laboratory confirmed COVID19 infection to 67 intensive care and high dependency units across the country. Data has been extracted and analysed at regular intervals to inform stakeholders and improve care practices. This is our 28th report including all patients with suspected or confirmed COVID-19 from 26th March 2020 to 26th December 2021. Key findings from 8624 patients who met eligibility criteria, are as follows: [bullet] Median age of 60 years (IQR 50-70). [bullet] The most common symptoms were shortness of breath (n = 6428, 77.8%), fever (n = 6091, 73.8%), and Cough (n = 3354, 38.9%) [bullet] The most common comorbidity was hypertension followed by diabetes. [bullet] During the course of illness 2804 (32.6%) patients received non-invasive ventilation, whereas 2474 (28.8%) patients had mechanical ventilation as their highest organ support. In addition, 2246 (26.1%) patients needed haemodynamic support and 1249 (14.7%) patients required renal replacement therapy as their highest organ support. [bullet] Median APACHE II score was 18 [bullet] Overall mortality at ICU discharge was 39.2% [bullet] Increasing age and requirement for invasive mechanical ventilation were independent risk factors for mortality increased the risk of death There is paucity of clinical characterization data from low-and middle-income countries such as Pakistan for critically ill COVID-19 patients. (4) (5) (6) (7) . The Pakistan Registry of Intensive Care (PRICE), established in 2018, and part of the Wellcome funded "CRIT Care Asia" recruits more than 2000 monthly critical care admissions across a national network in Pakistan (8) . Aim of this report is to provide clinicians and stakeholders in critical care services in Pakistan with real-time information regarding the incidence, clinical character and service utilisation throughout the COVID-19 pandemic. The same PRICE platform was adapted to incorporate ISARIC/WHO Clinical Characterization Protocol (CCP) tiers 0-3 capturing clinical and epidemiological data of patients admitted to the collaborating high dependency (HDU) and intensive care units (ICU) with clinically suspected or s re or . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted January 23, 2022. ; https://doi.org/10.1101/2022.01.20.22269202 doi: medRxiv preprint laboratory confirmed COVID19 infection (9) . A detailed description of data platform adaptation, data collection method and data management was published previously (9) . Variables were added using a standardized nomenclature, Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), that was already operationalized in the platform, enhancing interoperability at the organizational level and facilitating sharing with ISARIC (10). Data is captured contemporaneously to clinical care via the digital platform, with 24 hr cadence. Inbuilt field validation and range checks promote data quality. Data completeness for ISARIC tiers 0 and 1 was above 97% during a recent external performance review (11) . Information is entered in real-time from 67 participating units from 31 hospitals across the country and provides: A notification when a suspected case of COVID-19 is admitted Admission data for suspected COVID-19 cases, including demographics, characteristics, symptoms at presentation, comorbidities and travel history within 14 days Severity of illness, severity of illness assessed by Acute Physiology And Chronic Health Evaluation II (APACHE II) score Daily assessment of organ support and clinical treatments Discharge information, including status and outcome of any investigations to confirm COVID-19 diagnosis. All the enrolled patients in the registry were followed up to discharge and/or death. Statistical analysis was performed using R software (R core team 2021). The PRICE team are committed to ensuring the registry provides high quality information, whilst recognising the need for timely accessible information during these events. As such this information is collated and reported 'as captured'. This information may undergo revision as analysis evolves and is disseminated for the purpose of primary stakeholders to support clinical care and resource allocation. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted January 23, 2022. ; https://doi.org/10.1101/2022.01.20.22269202 doi: medRxiv preprint This is the twenty-eighth report summarising the data on all suspected or confirmed COVID-19 cases from the 26th March 2020 to 26th December 2021 admitted to critical care units within the PRICE network that agreed to report data on severe acute respiratory infection (SARI). A total of 8624 critical care admissions with suspected or confirmed SARI were reported ( Figure 1 ). . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted January 23, 2022. ; https://doi.org/10.1101/2022.01.20.22269202 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 23, 2022. ; https://doi.org/10.1101/2022.01.20.22269202 doi: medRxiv preprint Characteristics of patients with suspected SARI admitted to participating critical care units are summarised in Table 1 and 2, and these are compared with the characteristics of critically ill patients with non-SARI viral pneumonia during 2018-2021 from the same registry. The most common presenting symptoms were shortness of breath, fever and cough with no sputum. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 23, 2022. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 23, 2022. ; https://doi.org/10.1101/2022.01.20.22269202 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 23, 2022. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 23, 2022. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 23, 2022. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 23, 2022. ; https://doi.org/10.1101/2022.01.20.22269202 doi: medRxiv preprint 1 Data not available prior to SARI data collection. 2 Includes patients with confirmed viral pneumonia (n=81) and those with pneumonia (other, but not bacterial or fungal)) (n=58) Discharge data was available for 8521 patients. There were 5183 patients discharged alive from critical care (Figure 2) . Table 3 outlines the length of stay and outcome for critical care admissions, and compares it with non-SARI viral pneumonia patients during 2018-2021. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 23, 2022. ; https://doi.org/10.1101/2022.01.20.22269202 doi: medRxiv preprint One thousand six hundred seventy-five critical care admissions of suspected or confirmed SARI have been notified from 9th July 2021 to 26th December 2021. Of them, COVID-19 vaccine information has been received for 841(50.2%) patients. There, 321 (38.2%) patients were vaccinated while 520 (61.8%) patients have not got any COVID-19 vaccine. Alive 899 (51.6) 6 (60.0) . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted January 23, 2022. 1 *Data not available prior to SARI data collection. 2 **Vaccine information was enabled in the registry from 9th July 2021. 3 Includes patients with confirmed viral pneumonia (n=81) and those with pneumonia (other, but not bacterial or fungal)) (n=58) Covid-19-navigating the uncharted International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity Clinical characteristics of coronavirus disease 2019 in China Epidemiological and clinical features of SARS-CoV-2: a retrospective study from East Karachi Epidemiological and clinical characteristics of COVID-19: a retrospective multi-center study in Pakistan Clinical profiles, characteristics, and outcomes of the first 100 admitted COVID-19 patients in Pakistan: a single-center retrospective study in a tertiary care hospital of Karachi Clinical characteristics and outcomes of COVID-19: Experience at a major tertiary care center in Pakistan Pakistan Registry of Intensive CarE (PRICE): Expanding a lower middle-income, clinician-designed critical care registry in South Asia Leveraging a Cloud-Based Critical Care Registry for COVID-19 Pandemic Surveillance and Research in Lowand Middle-Income Countries Evaluation of the content coverage of SNOMED CT: ability of SNOMED clinical terms to represent clinical problem lists Performance evaluation of a multinational data platform for critical care in Asia Competing Interest: The authors have declared that no competing interests exist.