Introduction
Covid-19, the deadly corona virus hit Wuhan, China in December 2019 and later spread rapidly across the globe since January 2020 and was soon declared a pandemic by the WHO. SARS-CoV-2 has had a major impact on human health globally; infecting many people; causing severe disease and associated long-term health sequelae; resulting in excess mortality. It has had a negative impact on people and their physical and mental health.1 Globally, till 6 May 2022, there have been 513,955,910 confirmed cases of COVID-19, including 6249700 deaths, reported to WHO.1 India is one of the countries badly affected by the Covid-19. Kerala also showed similar statistics and the state is still struggling to overcome the virus infection related morbidities. In India, 42574719 cases and 524024 deaths have been reported till 7 May 2022.2 Whereas in Kerala, 6542660 cases and 69164 deaths have been reported till 3 May 2022.3, 4, 5, 1, 2, 6
A large number of individuals have undergone treatment for Covid 19 in Kerala. However not many reports are published from Kerala in scientific journals. This study was conducted to explore the profile of Covid 19 patients admitted, their symptom profile and the pattern of treatment received. Not many reports are published from Kerala in scientific journals regarding their clinical presentations. A few published reports are based on information through telephone contact or epidemiological data. This study was conducted to explore the profile of admitted patients- test confirmed of Covid 19 diagnosis. Their clinical characteristics, pattern of treatment and outcome was gathered.
Materials and Methods
This was a retrospective study conducted in a tertiary health care centre in Kerala. The study period and sample size were calculated as follows. The aims and objectives, methodolgy and study design was made into a protocol form and submitted before the institutional ethics committee and the clearance was obtained. The study was conducted from 1 December 2020 to March 31 2021. There were 613 patients who received IP care during the study period. A sample size of 123 was calculated and an additional 5 was decided for collecting data. The IP records were collected, studied and the data compiled. The first case record was selected randomly and every 5th case record was selected to reach the number. There were no exclusion criteria and every 5th record was included regardless of the treatment outcome. All the case records were taken and relevant data was recorded using a pre-designed proforma. The details collected included demographic profile, pre-existing co-morbidities, ground for treatment, number of days treated, category at the time of admission and category change if any during the stay, development of any known or unknown complications, treatment outcome. The collected information was compiled, analyzed and presented in tables.
Results
In total, 613 patients were admitted in covid ward/ICU from 1 December 2020 to March 31 2021 and out of them, 123 patients were selected randomly and their IP records were analysed. In the study, no significant gender difference was noted and males and females were equally involved. Maximum number of admitted patients belong to the younger to middle age group.
Table 1
Age and sex distribution of patients who received IP care
|
Age group |
Male |
Female |
Total |
|
Less than 1 |
1 |
3 |
4 |
|
1 to 4 |
3 |
2 |
5 |
|
5 to 14 |
0 |
2 |
2 |
|
15 to 44 |
24 |
24 |
48 |
|
45 to 59 |
16 |
14 |
30 |
|
60 and above |
20 |
19 |
39 |
|
Total |
64 |
64 |
128 |
Morbidity and death was more prominent among older age group, 93.75% death being in the above 45 year age group. Maximum number of patients discharged without any significant morbidity were in the younger 15 to 44 year age group. Certain patients who opted for outside treatment/home quarantine were classified under “discharge against medical advice ” group.
Table 2
Age wise outcome of patients who received IP care.
Table 3
Number of patients who had COVID related symptoms/comorbidities at the time of admission.
|
|
Yes |
No |
Not recorded |
Total |
|
Symptoms |
107 |
21 |
0 |
128 |
|
Comorbidity |
73 |
54 |
1 |
128 |
Table 4
List of co-morbidities and risk factors in patients whorecieved IP care
Table 5
Number of patients against Clinical category at the time of admission and the highest category the patient was in during the hospital stay
|
Clinical category |
At admission |
Highest category during hospital stay |
Change in category |
|
A |
53 |
52 |
-1 |
|
B |
47 |
46 |
+1 |
|
C |
26 |
28 |
+2 |
|
Not Recorded |
2 |
2 |
0 |
|
Total |
128 |
128 |
5 |
Change in category (+) indicates shift to higher category and worsening condition and (-) indicates shift to lower category following betterment of symptoms.
Majority of the patients fell under category A followed by B and then C.
Lung/heart/liver/kidney/neurologicaldisease/blooddisorders/uncontrolled diabetes/cancer/HIV-AIDS
On long term steroids
Pregnancy
Age > 60 years
Category C was defined as
Breathlessness, chest pain, drowsiness, fall in blood pressure, blood in sputum, cyanosis- bluish discoloration of skin/mucosa (red flag sign).
Children with influenza-like illness with red flag signs.
Somnolence, high or persistent fever, inability to feed well, convulsions, shortness of breath, respiratory distress.
Worsening of underlying conditions.
Discussion
In the study conducted to describe the clinical profile of Covid-19 patients admitted in a hospital Jaipur showed that male patients constituted 66.66% as compared to our present study where male-female ratio was found to be equal.
In both the studies, majority patients were found to be below 60 years of age. In their study 67% were found to be symptomatic whereas it was 83.6% in our study. 14.28% patients had comorbidities in their study in comparison to 57% with underlying co-morbidties in our study. In the study on clinico-demographic characteristics and in-hospital outcomes of a group of covid-19 patients in north India showed 93.1% of covid positive patients were males while in our study it was 50%. Co-morbidities were present in 15.9% whereas it was 57% in ours.
Oxygen requirement was required in 3.5% patients in their study while it was 22.8% in our study. In the study -The epidemiological data, co-morbidities, clinical symptoms, severity of illness and early outcome of patients with coronavirus disease from a tertiary care teaching hospital in New Delhi, India, 68.1% patients were males while it was 50% in our study. Any form of oxygen supplementation was required in 47.2% patients while it was 22.8% in our study.
Conclusion
In our study conducted on 123 Covid In-patients in a tertiary health care centre in Kerala, it was observed that affected male female ratio was equal. Most of the patients were above 15yrs ,the maximum affected age group being 15-44 yrs. About 83.6% were symptomatic. Out of 123, 57% had underlying comorbidities the most common being diabetes mellitus.While under treatment 22.8% different forms of oxygen supplementation pointing to the severity of illness.Out of 123 admitted cases (11.7%) died, (75%) recovered and discharged.
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