Comparison of clinical characteristics and short-term outcomes among COVID-19 patients in a tertiary care center during second wave pandemic in Nepal: a cross-sectional study

Abstract

Background: Coronavirus disease 2019 (COVID-19) emerged as a challenging pandemic globally. The clinical manifestations range from asymptomatic infection to severe respiratory failure. In-hospital mortality varies from 18.9% to 20.3%. Old age, male gender, co-morbidities, lower oxygen saturation, lymphopenia, raised C-reactive protein, and d-dimer levels increase the risk of critical illness and death. The objective of this study was to compare the clinical characteristics of COVID-19 patients and associated outcomes in a tertiary level hospital in Nepal. Methods: An analytical cross-sectional study was conducted in laboratory-confirmed COVID-19 patients admitted in a tertiary center of Nepal during the peak of the second wave of the pandemic. A non-probabilistic consecutive sampling technique was adopted. Data were analyzed using Statistical Package for the Social Sciences (IBM-SPSS), version-23. Mortality (yes/no) was the primary outcome of interest, and accordingly, the cases were divided into two groups, survivors and non-survivors. Bivariate and multivariate analyses were performed. Results: The overall in-hospital mortality was 84 (19.58%), and Intensive Care Unit (ICU) mortality was 36 (58.06%). The death rate was higher in cases presenting with shortness of breath and anorexia. Hypoxemic respiratory failure (16.08%) and acute respiratory distress syndrome (8.62%) were the most common complications associated with higher mortality. Patients with older age had higher odds of mortality (adjusted OR, 1.077; p<0.001). The risk of mortality was higher in severe to critically ill patients (adjusted OR, 5.861; p=0.001), and those who were under mechanical ventilation (adjusted OR, 39.059; p<0.001). Likewise, the duration of hospital stay was significantly associated with mortality (adjusted OR, 0.795; p<0.001). Conclusions: The non-survivors of COVID-19 tended to be of older age, severe to critically ill at presentation, require mechanical ventilation, and have a shorter duration of hospital stay, compared to survivors. So, these groups of patients need special care and support during hospital admission.