Keywords
Bangladesh, COVID-19, Critical care, Epidemiology, Clinical characteristics, Comorbidities, Managements
Abstract
Objectives: This study aimed to analyse the epidemiological and clinical characteristics of critical COVID-19 cases and investigate risk factors including comorbidities and age in relation with the clinical aftermath of COVID-19 in critical cases in Bangladesh.
Methods: In this retrospective study, epidemiological and clinical characteristics, complications, laboratory results, and clinical management of the patients were studied from data obtained from 168 individuals diagnosed with an advanced prognosis of COVID-19 admitted in two hospitals in Bangladesh.
Results: Individuals in the study sample contracted COVID-19 through community transmission. 56.5% (n = 95) cases died in intensive care units (ICU) during the study period. The median age was 56 years and 79.2% (n=134) were male. Typical clinical manifestation included Acute respiratory distress syndrome (ARDS) related complications (79.2%), fever (54.2%) and cough (25.6%) while diabetes mellitus (52.4%), hypertension (41.1%) and heart diseases (16.7%) were the conventional comorbidities. Clinical outcomes were detrimental due to comorbidities rather than age and comorbid individuals over 50 were at more risk. In the sample, oxygen saturation was low (< 95% SpO2) in 135 patients (80.4%) and 158 (93.4%) patients received supplemental oxygen. Identical biochemical parameters were found in both deceased and surviving cases. Administration of antiviral drug Remdesivir and the glucocorticoid, Dexamethasone increased the proportion of surviving patients slightly.
Conclusions: Susceptibility to developing critical illness due to COVID-19 was found more in comorbid males. These atypical patients require more clinical attention from the prospect of controlling mortality rate in Bangladesh.
References
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24
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25
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2. Li, B., et al., Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clinical research in cardiology, 2020. 109(5): p. 531-538.
3. Chan, K.S., et al., SARS: prognosis, outcome and sequelae. Respirology, 2003. 8 Suppl(Suppl 1): p. S36-40.
4. Badawi, A. and S.G. Ryoo, Prevalence of diabetes in the 2009 influenza A (H1N1) and the Middle East Respiratory Syndrome Coronavirus: A systematic review and meta-analysis. Journal of public health research, 2016. 5(3): p. 733-733.
5. Huang, C., et al., Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020. 395(10223): p. 497-506.
6. Wang, D., et al., Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. The journal of the American medical association, 2020. 323(11): p. 1061-1069.
7. Chen, N., et al., Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet, 2020. 395(10223): p. 507-513.
8. Guan, W.J., et al., Clinical characteristics of coronavirus disease 2019 in China. The New England journal of medicine, 2020. 382(18): p. 1708-1720.
9. Wynants, L., et al., Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal. British medical journal, 2020. 369: p. m1328.
10. Anwar, S., M. Nasrullah, and M.J. Hosen, COVID-19 and Bangladesh: Challenges and how to address them. Frontiers in public health, 2020. 8: p. 154-154.
11. (WHO), W.H.O. Clinical management of COVID-19. 2020 [cited 2020 23/09/2020]; Available from: https://www.who.int/publications/i/item/clinical-management-of-covid-19.
12. Islam, A.K.M.M. and A.A.S. Majumder, Hypertension in Bangladesh: a review. Indian heart journal, 2012. 64(3): p. 319-323.
13. Sutradhar, I., et al., Prevalence and risk factors of chronic obstructive pulmonary disease in Bangladesh: A systematic review. Cureus, 2019. 11(1): p. e3970-e3970.
14. Khanam, F., et al., Prevalence and risk factors of cardiovascular diseases among Bangladeshi adults: Findings from a cross-sectional study. Journal of epidemiology and global health, 2019. 9(3): p. 176-184.
15. Akter, S., et al., Prevalence of diabetes and prediabetes and their risk factors among Bangladeshi adults: a nationwide survey. Bulletin of the world health organization, 2014. 92(3): p. 204-213A.
24
16. Bishwajit, G., et al., Burden of asthma, dyspnea, and chronic cough in South Asia. International journal of chronic obstructive pulmonary disease, 2017. 12: p. 1093-1099.
17. Hussain, S.M.A., Comprehensive update on cancer scenario of Bangladesh. South Asian journal of cancer, 2013. 2(4): p. 279-284.
18. Ranieri, V.M., et al., Acute respiratory distress syndrome: the Berlin Definition. The journal of the American medical association, 2012. 307(23): p. 2526-33.
19. Singer, M., et al., The third international consensus definitions for Sepsis and Septic shock (Sepsis-3). The journal of the American medical association, 2016. 315(8): p. 801-810.
20. Mannan, A., et al., Epidemiology and clinical outcome of COVID-19: A multi-centre cross sectional study from Bangladesh. MedRxiv, 2020: p. 2020.09.09.20191114.
21. Grasselli, G., et al., Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. The journal of the American medical association, 2020. 323(16): p. 1574-1581.
22. Bhatraju, P.K., et al., Covid-19 in critically ill patients in the seattle region - case series. The new england journal of medicine, 2020. 382(21): p. 2012-2022.
23. Yu, Y., et al., Patients with COVID-19 in 19 ICUs in Wuhan, China: a cross-sectional study. Critical care, 2020. 24(1): p. 219.
24. Halvatsiotis, P., et al., Demographic and clinical features of critically ill patients with COVID-19 in Greece: The burden of diabetes and obesity. Diabetes research and clinical practice, 2020. 166: p. 108331-108331.
25. Richardson, S., et al., Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with covid-19 in the New York city area. The journal of the American medical association, 2020. 323(20): p. 2052-2059.
26. Rahman, M.S., et al., Awareness, treatment, and control of diabetes in Bangladesh: A nationwide population-based study. Plos one, 2015. 10(2): p. e0118365.
27. Antonicelli, L., et al., Severe asthma in adults does not significantly affect the outcome of COVID-19 disease: Results from the Italian Severe Asthma Registry. Allergy, 2020. n/a(n/a).
28. Kesici, S., S. Yavuz, and B. Bayrakci, Get rid of the bad first: Therapeutic plasma exchange with convalescent plasma for severe COVID-19. Proceedings of the national academy of sciences of the united states of america, 2020. 117(23): p. 12526-12527.
29. Stebbing, J., et al., COVID-19: combining antiviral and anti-inflammatory treatments. Lancet infect disease, 2020. 20(4): p. 400-402.
30. Irie, K., et al., Pharmacokinetics of Favipiravir in critically ill patients with COVID-19. Clinical and translational science, 2020. 13(5): p. 880-885.
31. Aschenbrenner, D.S., Remdesivir receives emergency use authorization for severely ill patients with ovid-19. AJN the American journal of nursing, 2020. 120(7).
32. Lamb, Y.N., Remdesivir: First approval. Drugs, 2020. 80(13): p. 1355-1363.
33. Wu, C., et al., Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. The journal of the American medical association, 2020. 180(7): p. 934-943.
34. Ledford, H., Coronavirus breakthrough: dexamethasone is first drug shown to save lives. Nature, 2020. 582(7813): p. 469.
35. Are Brazilian hospitals prepared for the COVID-19 pandemic? 2020; Available from: https://blog.brightcities.city/brazilian-hospitals/.
36. Díaz-Guio, D.A., et al., Will the Colombian intensive care units collapse due to the COVID-19 pandemic? Travel medicine and infectious disease, 2020: p. 101746-101746.
25
37. India has 8,432 ventilators and 9,512 ICU beds to fight Covid-19, ‘rapid upgrade’ needed: Report. Fcroll.in 2020; Available from: https://amp-scroll-in.cdn.ampproject.org/v/s/amp.scroll.in/latest/957195/to-tackle-covid-19-india-has-8432-ventilators-and-9512-icu-beds-report?usqp=mq331AQFKAGwASA%3D&_js_v=0.1#aoh=15997269002099&referrer=https%3A%2F%2Fwww.google.com&_tf=From%20%251%24s&share=https%3A%2F%2Fscroll.in%2Flatest%2F957195%2Fto-tackle-covid-19-india-has-8432-ventilators-and-9512-icu-beds-report.
38. Russia has over 177,000 beds for COVID-19 patients — deputy premier. Tass news agency 2020; Available from: https://tass-com.cdn.ampproject.org/v/s/tass.com/world/1162077/amp?usqp=mq331AQFKAGwASA%3D&_js_v=0.1#aoh=15996424289570&referrer=https%3A%2F%2Fwww.google.com&_tf=From%20%251%24s&share=https%3A%2F%2Ftass.com%2Fworld%2F1162077.
39. Nichols, B.E., et al., The role of remdesivir in South Africa: preventing COVID-19 deaths through increasing ICU capacity. medRxiv, 2020: p. 2020.06.10.20127084.
40. On the economic benefits and costs of covid-19 mitigation measures in Mexico. SSRN 2020 23/09/2020]; Available from: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3592209.
41. Kabir, F.H. Only 399 ICU beds amid virus spike. The financial express 2020; Available from: https://thefinancialexpress.com.bd/health/only-399-icu-beds-amid-virus-spike-1591415722.