key: cord-0706940-20bnoet8 authors: Karthaka, Christina; Baliga, Sulakshana S.; Walvekar, Padmaja R. title: Clinical profile and outcomes of COVID-19 positive patients -A cross sectional study date: 2021-11-29 journal: J Family Med Prim Care DOI: 10.4103/jfmpc.jfmpc_301_21 sha: bb1fffb9a8f8a25894d0ddec70a779e0e083813e doc_id: 706940 cord_uid: 20bnoet8 BACKGROUND: Globally 220 countries and territories are affected and cases of COVID-19 have increased by 8% resulting in 3.6 million new cases. The most common symptoms include fever, cough, loss of taste or smell, headache and mortality rate was uncertain. The objective of this study is to know the clinical profile and outcomes of COVID-19 positive patients. METHODOLOGY: A Cross-Sectional Study was conducted for 2 months (October–December 2020) among 727 COVID 19 positive patients residing in the field practice area of 4 health centers. Details regarding medical history, exposure history, underlying co-morbidities, symptoms, signs clinical features and outcomes (i.e, cured, mortality, and length of stay) were obtained. RESULTS: The mean age of participants was 41 ± 17 years, 59.28% were males, 40.71% were females. A significant association was found between age, family history of disease, co-morbid disease, medication history, smoking habit, alcohol consumption, type of symptoms, isolation type, treatment given with outcomes (P < 0.05). Subjects with previous history of medication (HR, 2.749; 95% CI 1.0774–7.015), and those who had symptoms (HR, 3.6446; 95% CI1.0280–12.921) were associated with increased risk of death as compared to others. CONCLUSION: COVID-19 positive was found in 56% of patients, they were less severe and improved with medication and deaths were found in 3.85% of patients. Fever was noted in only 15.72% of patients, gastrointestinal symptoms in 1.22% and respiratory symptoms in 14.74% of patients. Participants with older age were significantly associated with complications and those with co-morbidities were significantly associated with death on multinominal logistic analysis. Introduction heterogenicity of illness across the world especially India. This article information gives the baseline statistics at the community level to devise plans in order to contain COVID-19 in the present pandemic. Hence, this study was planned to know the clinical profile and outcomes of COVID-19 positive patients. COVID 19 positive patients residing in the field practice area for more than 1 year who tested positive on by real-time reverse transcriptase polymerase chain reaction (RAT/RT-PCR) either by throat or nasopharyngeal swab were included. Participants who do not belong to field practice area such as migrant workers, travelers, and relatives who visited the houses in the field practice area and became positive were excluded. All the COVID positive patients in the field practice area were line-listed as per the Belagavi District COVID positive patients list from the four field practice areas under the department of Community Medicine, JNMC, KAHER Belagavi. A total of 727 COVID-positive patients were included. Data were collected after obtaining written informed consent from the study participants. While a telephonic consent was obtained from the quarantined family members if the patient was unable to give consent himself/herself Participants were interviewed using a pre-designed, pretested questionnaire which included details such as socio-demography, medical history, exposure history, underlying co-morbidities, symptoms, signs clinical features, and outcomes. Clinical outcomes were studied by reviewing discharge summary records of the participants. Two health care workers in each centre were trained to collect the reports of COVID-positive patients and retrieve the information. Data were cross-checked to avoid errors and clinical outcomes were analyzed. In case of death of the patient their household members were interviewed. If none are available the information was collected from the ANM/ASHA workers. Ethical clearance permission was obtained from Institutional Ethics Committee wide number (MDC/DOME/447) on 10/12/2020. Data is analyzed using statistical software R version 4.0.2 and Microsoft Excel. Continuous variables were represented by mean ± SD and categorical variables represented by frequency. To check the association between categorical variables Monte-Carlo's simulation is used. To compare mean/distributions over groups ANOVA test is used. To check the variable effecting the outcomes multinomial logistic regression is used. Cox proportional hazard model is used to find the variables affecting mortality. A value of P ≤ 0.05 indicates statistical significance. Table 1 shows that maximum participants were between 21 and 40 years of age with mean age of study participants was 41.12 ± 17.2 years. There were 431 males and 296 females with male predominance (1:1.46). Approximately 37 (5.09%) subjects were health workers, 26.27% had completed secondary schooling. Only 6.46% of participants had health insurance. Among 727, 104 subject's family suffered with COVID-19. Approximately 44.02% subjects were asymptomatic. Fever was reported in only 15.72% patients, respiratory symptoms in 14.74%, and gastrointestinal symptoms in 1.22% patients. Mean duration of fever observed was 6.18 ± 4.15 days. We observed 3.85% of the subjects died due to COVID-19. Nearly 38 participants had ICU admissions and required ventilator support among which few had developed pneumonia. Among 28 deaths recorded one of them died of liver failure and one more due to sepsis. A significant association was found between age, family history of disease, co-morbid disease, medication history, smoking habit, alcohol consumption, type of symptoms, isolation type, treatment given with outcomes (P < 0.05). Table 2 shows that by ANOVA, there was a significant difference in the age over outcomes. Tukey's test was used for post hoc analysis. From Tukey's test, there was a significant difference in the age between cured complications (P = 0.00060), cured-death (P = 0.0065). Table 3 shows that for unit increase in age there was an increase in log odds of outcome as complications compared to cured by 10 .4583 in the participants on Antibiotic treatment compared to participants on all three, that is, anti-biotic, anti-viral therapy, and steroids. The log odds of complications Vs cured increased by 1.1839 in participants who were on those who were on all three i.e Anti-viral therapy treatment compared to anti-biotic, anti-viral therapy, and steroids. The log odds of death Vs cured increased by 1.3528 among the participants who were only on anti-viral therapy. Table 4 shows that among the study subjects with previous medication history hazard ratio was 2.7491 times more compared to the subjects without previous medication history. Among the participants with symptoms of COVID-19 hazard ratio was 3.6446 times more when compared to the subjects without any symptoms. Figure 1a shows that participants who were already on some medications due to chronic illness (diabetes, hypertension) had 2.75 times risk of death when compared to those participants who were on no medication. Symptomatic patients had 3.64 times risk of death when compared to asymptomatic. COVID-19 had a major impact on human population. It has caused disruption of normal life. The centre and state governments have imposed several regulations to contain its spread. Despite the efforts it has led to 143355 deaths in India and 1605091 worldwide. [1, 8] Thus the current study explores the profile of covid positive patients, their clinical presentation, and outcomes to look for novelty and substantial heterogenicity of illness across the world especially India. Our study showed that mean age of participants was 41.12 ± 17.2 years similar to studies [2, 5] done in India but differed from those done in China and Europe. [9, 10] This shows that epidemiological presentation of infection varies between geographical location. Majority of them were between 21-40 years age group among which 60% were males and rest were females. These results were similar to study done in tertiary care centre in India. [2, 11] The mean duration of hospital stay was 10.63 ± 4.26 days and the risk of complications and death (P < 0.0004998* MC ) significantly increased among hospitalized patients. In all the studies [2, 4, 5, 12, 9, 11] found till date fever is the most common symptom, the mean duration of fever in our study was 6.18 ± 4.15 days and other symptoms include sore throat, cough, myalgia. About 6 participants reported loss of smell/taste. It was found that The log odds of complications Vs cured increased by 0.8376 for the person with symptoms of COVID-19. The log odds of death Vs cured also increased by 1.9335 for the person with symptoms of COVID-19. In our study factors such as increase in age (P < 0.00001* A ), positive family histor y of NCD's (P < 0.00001*), c o -m o r b i d i t i e s ( P < 0 . 0 0 0 5 * M C ) a n d t h o s e o n medication (P < 0.0004998* MC ) have shown increased risk of complications among the participants. The most common co-morbidity reported was hypertension in 5% and diabetes in 3.4% and others had combination of hypertension, diabetes and asthma which were in par with other studies. [2, 5, 6, 11, 13] Nearly 68% have received antiviral therapy and were cured (P < 0.01549* MC ). Rest of them have received a combination of antibiotics, antivirals, steroids, vitamin C, and zinc. We have also found that The log odds of death Vs cured decreased by 10.4583 for the participants on Antibiotic treatment compared to anti-biotic, anti-viral therapy, and steroids which was similar to other study in Jakarta. [13] With regard to our study subjects with previous history of medication (HR, 2.749; 95% CI 1.0774-7.015), and those who had symptoms (HR, 3.6446; 95% CI1.0280-12.921) were associated with increased risk of death as compared to others. Nearly 38 participants had ICU admissions and required ventilator support among which few had developed pneumonia. Among 28 deaths recorded one of them died of liver failure and one more due to sepsis. These results were similar to other studies. [5, 10, 14] Conclusion To conclude though symptomatic COVID-19 positive was found in 56% of patients, they were less severe and improved with medication and deaths were found in 3.85% of patients. Fever was noted in only 15.72% of patients, gastrointestinal symptoms in 1.22% and respiratory symptoms in 14.74% of patients. Participants with older age were significantly associated with complications and those with co-morbidities were significantly associated with death on multinominal logistic analysis. A significant association was found between age, family history of non-communicable diseases, medication history habit of smoking, alcohol consumption, type of symptoms, and treatment without outcomes. Controlling the spread of COVID-19 and reducing death as soon as possible requires contained control efforts especially at the grass-root level. 1. We could include only laboratory confirmed cases but suspected and undiagnosed cases were not included in our study 2. There are chances of recall bias This cross-sectional study revealed that more than half of the participants were symptomatic. Among those who had proven risk factors such as increase in age with associated co-morbidities had increased risk of hospital isolation which in turn led to increased risk of complications and death as compared to home isolates. Hence early detection and treatment of the patients is required to prevent complications and deaths. In any community as front line workers from primary health care setting are the first to come into contact with a positive case and are involved in isolation and management of mild and moderate cases it is important to know the clinical profile and associated co-morbidities in a case so that along with hand hygiene, wearing of masks and social distancing those with co-morbidities and elderly can be advised for reverse isolation. The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. WHO official updates-Coronavirus Clinical and epidemiologic profile of the initial COVID-19 patients at a tertiary care centre in India Cardiovascular risks in patients with COVID-19: Potential mechanisms and areas of uncertainty Clinical characteristics, comorbidities, and outcome among 365 patients of Coronavirus disease 2019 at a Tertiary care centre in Central India Clinico-demographic profile and hospital outcomes of COVID-19 patients admitted at a Tertiary care centre in North India Comorbidity and its impact on patients with COVID-19 Impact of cardiovascular risk profile on COVID-19 outcome. 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