Abstract
BackgroundRisk factors for the development of severe COVID-19 disease and death have been widely reported across several studies. Knowledge about the determinants of severe disease and mortality in the Indian context can guide early clinical management.MethodsWe conducted a hospital-based case control study across nine sites in India to identify the determinants of severe and critical COVID-19 disease.FindingsWe identified age above 60 years, duration before admission >5 days, chronic kidney disease, leucocytosis, prothrombin time > 14 sec, serum ferritin >250 ng/mL, d-dimer >0.5 ng/mL, pro-calcitonin >0.15 μg/L, fibrin degradation products >5 μg/mL, C-reactive protein >5 mg/L, lactate dehydrogenase >150 U/L, interleukin-6 >25 pg/mL, NLR ≥3, and deranged liver function, renal function and serum electrolytes as significant factors associated with severe COVID-19 disease.InterpretationWe have identified a set of parameters that can help in characterising severe COVID-19 cases in India. These parameters are part of routinely available investigations within Indian hospital settings, both public and private. Study findings have the potential to inform clinical management protocols and identify patients at high risk of severe outcomes at an early stage.
Highlights
COVID-19 pandemic has caused over 2.4 million deaths and over 111 million cases worldwide by 24th February 2021 [1]
We identified age above 60 years, duration before admission >5 days, chronic kidney disease, leucocytosis, prothrombin time > 14 sec, serum ferritin >250 ng/mL, d-dimer >0.5 ng/ mL, pro-calcitonin >0.15 μg/L, fibrin degradation products >5 μg/mL, C-reactive protein >5 mg/L, lactate dehydrogenase >150 U/L, interleukin-6 >25 pg/mL, neutrophil lymphocyte ratio (NLR) 3, and deranged liver function, renal function and serum electrolytes as significant factors associated with severe COVID-19 disease
We have identified a set of parameters that can help in characterising severe COVID-19 cases in India
Summary
COVID-19 pandemic has caused over 2.4 million deaths and over 111 million cases worldwide by 24th February 2021 [1]. Critical care resources have been stretched across some countries [2, 3]. The fatalities reported by countries and regions varied widely. India rapidly scaled up hospital and critical care resources and a proactive public health response targeting surveillance, wearing masks, limiting movement in the early phase of the epidemic along with an intensive information dissemination campaign. The mortality attributed to COVID-19 in India was relatively low compared to the rest of the world. India had reported 1,19,71,624 cases and 1,61,552 deaths till 28 March 2021 with lowest case fatality ratio of 1.5% globally [5]. Risk factors for the development of severe COVID-19 disease and death have been widely reported across several studies. Knowledge about the determinants of severe disease and mortality in the Indian context can guide early clinical management
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