Comparison of Clinical, Haematological, Biochemical Findings and Significance of Co-morbidities amongst COVID-19 Positive Survivors and Nonsurvivors

Abstract

Introduction: Corona virus 2019 was first isolated in 1960. Middle East Respiratory Syndrome virus (MERS) and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) also belongs to Corona viridae family. Human Coronavirus causes fever, cough, fatigue, respiratory infection and abdominal symptoms. This virus has a strong affinity to human respiratory receptors and transmits rapidly. Since the virus has spread around the world and has acquired features of emergency, WHO declared it as a pandemic in March 2020. Aim: To study the clinical, haematological, biochemical findings and significance of co-morbidities amongst COVID-19 positive survivors and nonsurvivors. Materials and Methods: A retrospective cohort study was done at Chattrapati Shivaji Subharti Hospital (CSSH), Meerut, Uttar Pradesh, a level 3 COVID-19 Hospital from mid-June to end of August 2020 including 140 COVID-19 positive patients selected randomly. Patients were categorised into asymptomatic and symptomatic. Symptomatic were further divided into survivors and nonsurvivors. Haematological and biochemical parameters were analysed amongst survivors and nonsurvivors, with calculation of significant p-value. Results: Out of total 140 patients, 37/140 patients (26%) were asymptomatic and 103/140 (74%) symptomatic. Amongst symptomatic, survivors were 78/140 (56%) and nonsurvivors were 25/140 (18%) of total positive patients. Out of 37/140 (26%) asymptomatic patients, majority were in the age group 21-30 years 14/140 (10%) with female preponderance 10/140 (7.1%). Out of 78/140 (56%) survivors, majority were in 51 to 60 years age group, with male predominance17/140 (18.6%). Amongst 25/140 (18%) nonsurvivors most common affected age group was 51 to 60 years 10/140 (7.1%). Most common symptoms in survivors was cough (51/78 patients; 65%) and fever (35/78 patients; 45%). In Nonsurvivors, pneumonia was seen in 100% (25/25) patients. Out of 23/25 (92%) patients presented with fever, 19/25 (76%) had breathlessness, 16/25 (64%) had myalgia, 9/25 (36%) had cough, 5/25 (20%) presented with vomiting or pain in abdomen. Amongst nonsurvivors, Total Leucocyte Count (TLC), Absolute Neutrophil Count (ANC), Neutrophil Lymphocyte Ratio (NLR), urea, serum creatinine, serum bilirubin, Aspartate Amino Transferase (AST) and Alanine Amino Transferase (ALT) were significantly raised as compared to survivors (p<0.01); meanwhile platelet count and Platelet Lymphocyte Ratio (PLR) in nonsurvivors was significantly lower than survivors (p<0.01). Most common comorbidity was diabetes in 12/25 (48%) and hypertension in 6/25 (24%) among nonsurvivors. Conclusion: COVID-19 infection more likely affects older men with co-morbidities like diabetes mellitus and hypertension and can rapidly progress to pneumonia, Acute Respiratory Distress Syndrome (ARDS) and septic shock. Certain haematological and biological parameters have been found to be in concordance with increased mortality which can be reduced by early identification of these parameters.