key: cord-0785145-4ts41jgh
authors: Tsertsvadze, T.; Ezugbaia, M.; Endeladze, M.; Ratiani, L.; Javakhishvili, N.; Mumladze, L.; Khotcholava, M.; Janashia, M.; Zviadadze, D.; Gopodze, L.; Gokhelashvili, A.; Metchurchtlishvili, R.; Abutidze, A.; Chkhartishvili, N.
title: Characteristics and outcomes of hospitalized adult COVID-19 patients in Georgia
date: 2020-10-27
journal: nan
DOI: 10.1101/2020.10.23.20218255
sha: 859ffd20ae4ea30f3f5c4af47e981c462e843cc6
doc_id: 785145
cord_uid: 4ts41jgh

Objective: Describe presenting characteristics of hospitalized patients and explore factors associated with in-hospital mortality during the first wave of pandemic in Georgia. Methods: This retrospective study included 582 adult patients admitted to 9 dedicated COVID-19 hospitals as of July 30, 2020 (72% of all hospitalizations). Data were abstracted from medical charts. Factors associated with mortality were evaluated in multivariable Poisson regression analysis. Results: Among 582 adults included in this analysis 14.9% were 65+ years old, 49.1% were women, 59.3% had uni- or bi-lateral lung involvement on chest computed tomography, 27.1% had any co-morbidity, 13.2% patients had lymphopenia, 4.1% had neutophilosis, 4.8% had low platelet count, 37.6% had d-dimer levels of >0.5 mcg/l. Overall mortality was 2.1% (12/582). After excluding mild infections, mortality among patients with moderate-to-critical disease was 3.0% (12/399), while among patients with severe-to-critical disease mortality was 12.7% (8/63). Baseline characteristics associated with increased risk of mortality in multivariate regression analysis included: age [≥]65 years (RR: 10.38, 95% CI: 1.30-82.75), presence of any chronic co-morbidity (RR: 20.71, 95% CI: 1.58-270.99), lymphopenia (RR: 4.76, 95% CI: 1.52-14.93), neutrophilosis (RR: 7.22, 95% CI: 1.27-41.12), low platelet count (RR: 6.92, 95% CI: 1.18-40.54), elevated d-dimer (RR: 4.45, 95% CI: 1.48-13.35), elevated AST (RR: 6.33, 95% CI: 1.18-33.98). Conclusion: In-hospital mortality during the first wave of pandemic in Georgia was low. We identified several risk factors (older age, co-morbidities and laboratory abnormalities) associated with poor outcome that should provide guidance for planning health sector response as pandemic continues to evolve.

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 October 27, 2020. ; 70   71   This retrospective study included unselected consecutive patients with RT-PCR confirmed  72 COVID-19 admitted to 9 designated COVID-19 hospitals across the country between February 73 26 and July 30, 2020, for whom complete outcome data was known (discharged alive or died in 74 hospital 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 October 27, 2020. ; Mortality rates by severity of disease at presentation were: 0.0% (0/183) for mild disease, 1.2% 114 (4/336) for moderate, 3.8% (2/53) for severe disease and 60% (6/10) for critical disease (Table  115 . 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 October 27, 2020. ;

2). After excluding mild infections, mortality among patients with moderate-to-critical disease 116 was 3.0% (12/399), while among patients with severe-to-critical disease mortality was 12. (1.0%) cardiovascular events (3 acute coronary disease, 2 ischemic strokes, 1 haemorrhagic 123 stroke), 19 (3.3%) sepsis/septic shock, 6 (1.0%) acute liver injury, 10 (1.7%) acute kidney injury, 124 19 (3.3%) cytokine storm (Table 2) . Forty-one (7.0%) patients required admission to ICU 125 resulting in 12 deaths (29.3% mortality) and 44 (7.6%) patients required oxygen support 126 resulting in 12 deaths (27.3% mortality) ( Table 2) . 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 October 27, 2020. ;

In this cohort of consecutive hospitalized adult patients with laboratory confirmed COVID-19 we 141 found low in-hospital mortality of 2.1% among total population, 3% -among patients with at 142 least moderate disease and 12.7% among patient with at least severe disease at presentation. 143

Overall mortality shown in our study is lower than 18.88% reported in recent meta-analysis, even 144 if we limit our analysis to patients with severe/critical disease (2). However, the difference needs 145 to be interpreted with caution in light of varying criteria for hospitalization and rationing of 146 resources in overburdened healthcare systems (3). Reported rates of mortality among patients 147 admitted to ICU or requiring ventilation ranges between 23% and 53% (4-7), with our study 148

showing mortality of 29.3%. 149 150 Similar to other studies older age, presence of chronic comorbidities and laboratory 151 abnormalities (leukopenia, neutrophilosis, thromocytopeia and increase in d-dimer) have been 152 significantly associated with mortality (8-11). Interestingly, our data did not show gender-based 153 differences neither in univariate nor multivariate analysis., while reports from other countries 154 universally indicate increased risk of death among men (12). 155 156 Predicting outcomes of COVID_19 disease has been a subject of intensive research (13). This is 157 particularly important for Georgia as the country moved from hospitalize all approach to 158 outpatient care of persons with mild disease because of significant increase in diagnosis since 159

September 2020 (1). Defining criteria for hospitalization is crucial for appropriate utilization of 160 healthcare resources without compromising lives. In our study baseline clinical characteristics, 161 . 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 October 27, 2020. ; such as fever, abnormalities in respiratory rate, oxygen saturation and chest CT imaging showed 162 significant association with mortality only in univariate analysis. As an example, 4 patients in 163 our cohort, initially classified to have moderate disease, had significant deterioration of their 164 condition leading to death. All these 4 patients had pre-existing cardiovascular disease, 3 had 165 elevated d-dimer along with lymphopenia -combination of factors that had been shown to 166 predict progression of disease (14). This suggests that initial clinical presentation may not be 167 sufficient for predicting outcome, it is rather complex issue that requires combinations of several 168 determinants, including laboratory parameters. 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 October 27, 2020. ; 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 October 27, 2020. . 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 October 27, 2020. ;

. 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 October 27, 2020. ;

European Centre for Disease Prevention and Control. Situation dashboard -COVI-19

Stockholm: ECDC; 2020

COVID-19 Patients: A Meta-Analysis

Fair Allocation 192 of Scarce Medical Resources in the Time of Covid-19

Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New 196

York: retrospective case series

Features 198 of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical 199

Characterisation Protocol: prospective observational cohort study

Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of 202 the Lombardy Region, Italy. Jama

Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 205 920 German hospitals: an observational study

The Effect of Age on Mortality in Patients With COVID-19: A Meta

With 611,583 Subjects

Comorbidities 210 associated with mortality in 31,461 adults with COVID-19 in the United States: A federated 211 electronic medical record analysis

Factors associated with mortality in patients 213 with COVID-19. A quantitative evidence synthesis of clinical and laboratory data

D dimer levels on admission to 216 predict in hospital mortality in patients with Covid 19

COVID-19 and Sex Differences: Mechanisms and Biomarkers

Systematic evaluation and external validation of 22 prognostic models among hospitalised adults 223 with COVID-19: An observational cohort study

Early prediction of disease 225 progression in COVID-19 pneumonia patients with chest CT and clinical characteristics