Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan
A prospective cohort study was conducted at the Indus Hospital Karachi, Pakistan between March and June 2020 to estimate the in-hospital mortality among hospitalized COVID-19 patients and its determinants. A total of 170 adult patients were enrolled and all-cause mortality was found to be 39% (67/17...
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| description | A prospective cohort study was conducted at the Indus Hospital Karachi, Pakistan between March and June 2020 to estimate the in-hospital mortality among hospitalized COVID-19 patients and its determinants. A total of 170 adult patients were enrolled and all-cause mortality was found to be 39% (67/170). Most non-survivors were above 60 years of age (64%) while gender distribution was quite similar in both groups (males: 77% vs 78%). Most (80.6%) non-survivors came with peripheral oxygen saturation less than 93% while 95% of them had critical disease on arrival. Use of non-invasive ventilation in emergency room was higher among non-survivors (56.7%) versus survivors (26.2%). Median Interleukin-6 levels were higher among non-survivors (78.6: IQR = 33.8-49.0) compared to survivors (21.8: IQR = 12.6-36.3). Most patients in the non-survivor group (86.6%) required invasive ventilator support during hospital stay compared to 7.8% in the survivors. The median duration of ICU stay was longer for non-survivors (9: IQR = 6-12) compared to survivors (5: IQR = 3-7) days. Univariable binary logistic regression showed that age above 60 years, oxygen saturation below 93%, Neutrophil to lymphocyte ratio above 5, procalcitonin above 2ng/ml, unit increase in SOFA score and arterial lactate levels were associated with mortality. We also found that a unit decrease in Pao2/FiO2 ratio and serum albumin were associated with mortality in our patients. Multivariable regression showed that age above 60 years (aOR = 3.4: 95% CI = 1.6-6.9), peripheral oxygen saturation below 93% (aOR = 3.5:95% CI = 1.6-7.7) and serum pro-calcitonin above 2ng/ml (aOR = 4.8; 95% CI = 1.9-12.2) were associated with higher odds of mortality when adjusted by month of admission. Most common cause of death was multisystem organ failure in 35 (56.6%) non-survivors while 22 (35.5%) died due to respiratory failure. Larger prospective studies are needed to further strengthen these findings. |
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A total of 170 adult patients were enrolled and all-cause mortality was found to be 39% (67/170). Most non-survivors were above 60 years of age (64%) while gender distribution was quite similar in both groups (males: 77% vs 78%). Most (80.6%) non-survivors came with peripheral oxygen saturation less than 93% while 95% of them had critical disease on arrival. Use of non-invasive ventilation in emergency room was higher among non-survivors (56.7%) versus survivors (26.2%). Median Interleukin-6 levels were higher among non-survivors (78.6: IQR = 33.8-49.0) compared to survivors (21.8: IQR = 12.6-36.3). Most patients in the non-survivor group (86.6%) required invasive ventilator support during hospital stay compared to 7.8% in the survivors. The median duration of ICU stay was longer for non-survivors (9: IQR = 6-12) compared to survivors (5: IQR = 3-7) days. Univariable binary logistic regression showed that age above 60 years, oxygen saturation below 93%, Neutrophil to lymphocyte ratio above 5, procalcitonin above 2ng/ml, unit increase in SOFA score and arterial lactate levels were associated with mortality. We also found that a unit decrease in Pao2/FiO2 ratio and serum albumin were associated with mortality in our patients. Multivariable regression showed that age above 60 years (aOR = 3.4: 95% CI = 1.6-6.9), peripheral oxygen saturation below 93% (aOR = 3.5:95% CI = 1.6-7.7) and serum pro-calcitonin above 2ng/ml (aOR = 4.8; 95% CI = 1.9-12.2) were associated with higher odds of mortality when adjusted by month of admission. Most common cause of death was multisystem organ failure in 35 (56.6%) non-survivors while 22 (35.5%) died due to respiratory failure. Larger prospective studies are needed to further strengthen these findings.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0251754</identifier><identifier>PMID: 34043674</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Antibiotics ; Biology and Life Sciences ; Care and treatment ; Cohort analysis ; Coronaviruses ; COVID-19 ; Demography ; Drafting software ; Editing ; Electronic mail ; Emergency medical care ; Emergency medical services ; Engineering and Technology ; Fatalities ; Hospital patients ; Immunogenicity ; Infectious diseases ; Lactic acid ; Medicine and Health Sciences ; Methodology ; Mortality ; Oxygen ; Oxygen content ; Pandemics ; Patient outcomes ; Physical Sciences ; Pneumonia ; Procalcitonin ; Public health ; Research and Analysis Methods ; Research facilities ; Respiration ; Respiratory diseases ; Respiratory distress syndrome ; Respiratory rate ; Saturation ; Seasonal variations ; Septic shock ; Severe acute respiratory syndrome ; Severe acute respiratory syndrome coronavirus 2 ; Viral diseases</subject><ispartof>PloS one, 2021-05, Vol.16 (5), p.e0251754-e0251754</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Sarfaraz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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Samina</au><au>Hussain, Aneela</au><au>Cheungpasitporn, Wisit</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan</atitle><jtitle>PloS one</jtitle><date>2021-05-27</date><risdate>2021</risdate><volume>16</volume><issue>5</issue><spage>e0251754</spage><epage>e0251754</epage><pages>e0251754-e0251754</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>A prospective cohort study was conducted at the Indus Hospital Karachi, Pakistan between March and June 2020 to estimate the in-hospital mortality among hospitalized COVID-19 patients and its determinants. A total of 170 adult patients were enrolled and all-cause mortality was found to be 39% (67/170). Most non-survivors were above 60 years of age (64%) while gender distribution was quite similar in both groups (males: 77% vs 78%). Most (80.6%) non-survivors came with peripheral oxygen saturation less than 93% while 95% of them had critical disease on arrival. Use of non-invasive ventilation in emergency room was higher among non-survivors (56.7%) versus survivors (26.2%). Median Interleukin-6 levels were higher among non-survivors (78.6: IQR = 33.8-49.0) compared to survivors (21.8: IQR = 12.6-36.3). Most patients in the non-survivor group (86.6%) required invasive ventilator support during hospital stay compared to 7.8% in the survivors. The median duration of ICU stay was longer for non-survivors (9: IQR = 6-12) compared to survivors (5: IQR = 3-7) days. Univariable binary logistic regression showed that age above 60 years, oxygen saturation below 93%, Neutrophil to lymphocyte ratio above 5, procalcitonin above 2ng/ml, unit increase in SOFA score and arterial lactate levels were associated with mortality. We also found that a unit decrease in Pao2/FiO2 ratio and serum albumin were associated with mortality in our patients. Multivariable regression showed that age above 60 years (aOR = 3.4: 95% CI = 1.6-6.9), peripheral oxygen saturation below 93% (aOR = 3.5:95% CI = 1.6-7.7) and serum pro-calcitonin above 2ng/ml (aOR = 4.8; 95% CI = 1.9-12.2) were associated with higher odds of mortality when adjusted by month of admission. Most common cause of death was multisystem organ failure in 35 (56.6%) non-survivors while 22 (35.5%) died due to respiratory failure. Larger prospective studies are needed to further strengthen these findings.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>34043674</pmid><doi>10.1371/journal.pone.0251754</doi><tpages>e0251754</tpages><orcidid>https://orcid.org/0000-0001-6106-2713</orcidid><orcidid>https://orcid.org/0000-0002-1218-3962</orcidid><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_2533252562 |
| source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Antibiotics Biology and Life Sciences Care and treatment Cohort analysis Coronaviruses COVID-19 Demography Drafting software Editing Electronic mail Emergency medical care Emergency medical services Engineering and Technology Fatalities Hospital patients Immunogenicity Infectious diseases Lactic acid Medicine and Health Sciences Methodology Mortality Oxygen Oxygen content Pandemics Patient outcomes Physical Sciences Pneumonia Procalcitonin Public health Research and Analysis Methods Research facilities Respiration Respiratory diseases Respiratory distress syndrome Respiratory rate Saturation Seasonal variations Septic shock Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Viral diseases |
| title | Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-26T05%3A48%3A40IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Determinants%20of%20in-hospital%20mortality%20in%20COVID-19;%20a%20prospective%20cohort%20study%20from%20Pakistan&rft.jtitle=PloS%20one&rft.au=Sarfaraz,%20Samreen&rft.date=2021-05-27&rft.volume=16&rft.issue=5&rft.spage=e0251754&rft.epage=e0251754&rft.pages=e0251754-e0251754&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0251754&rft_dat=%3Cgale_plos_%3EA663279448%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2533252562&rft_id=info:pmid/34043674&rft_galeid=A663279448&rft_doaj_id=oai_doaj_org_article_8a6148a9269141bc8303654986185070&rfr_iscdi=true |