Aims: To observe outcomes in patients admitted to the High Dependency Unit (HDU) at the Field Isolation Centre Karachi after 14 days of COVID-19 treatment protocol.
Patients and methods: This cross-sectional study was conducted at HDU/FIC Karachi at Expo Centre. The duration of the study was from 1st December 2020 to 10th March 2021. All patients diagnosed as cases of COVID-19, of both genders with age ranging from 18 to 91 years were included.
Methodology: All patients were treated according to the protocols set as under:
Anti-viral drug Remdesivir was given in all patients aged less than 75 years, with moderate to severe disease (based on clinical classification released by National Health Commission of China). Dexamethasone 6mg IV once daily was initiated in all oxygen dependent patients and increased to twice daily if Ferritin levels were greater than 1000ug/L. As a supportive treatment, patients with moderate or severe disease were given Injection Enoxaparin in prophylactic dose and in therapeutic dose for patients with elevated D-Dimer levels. Along with this, superadded bacterial infections were covered with broad-spectrum antibiotics and adjusted as per culture and sensitivity. Patients were also given Famotidine (H-2 receptor blocker), and anti-hyperlipidemic drug Fenofibrate based on initial supportive literature. But in patients with known liver diseases or with deranged ALT levels ≥ 5 times upper limits of normal, Fenofibrate and Remdesivir were discontinued.
All data regarding the medications given, oxygen demand, disease severity and co-morbid conditions and the outcome on 14th day of admission was collected through the online HMIS database and patient files, on pre-approved Performa. Patients’ confidentiality was ensured.
Results: A total of 183 patients were included in the study. There were 66.7% male and 33.3% female patients with a mean age 59.01±14.83 years. Majority (72.1%) of patients were of more than 50 years of age. Among 183 patients, 2.2% were smokers, 51.9% were hypertensive and 41% were diabetic while 5.5% had ischemic heart disease, and 3.8% were found with asthma. We found 84.7% with shortness of breath, 67.8% of patients with fever, 57.9% with cough, 17.5% with myalgia, 14.8% with fatigue, 4.9% with diarrhea, 2.7% with nausea and 1.6% with vomiting. In our study, 35% of patients expired. Out of 183 patients, 147 patients needed oxygen at the time of admission, which was reduced to 45 patients after 2 weeks, while 26 patients need NIV at admission, reduced to 21 patients on NIV after 2 weeks. We found significant mean difference of age (p=0.000) while significant association of outcome was found with Remdesivir given (p=0.039), cough (p=0.025), intubation after 2 weeks (p=0.006), Oxygen need at admission (p=0.000), Oxygen need after 2 weeks (p=0.000), NIV Need at admission (p=0.000) and NIV Need after 2 weeks (p=0.000).
Conclusion: This study revealed various characteristics (age, supplemental oxygen requirement and comorbid conditions) of COVID-19 patients to be associated with poor outcome at 14th day of admission. Remdesivir was found to decrease mortality, especially in patients with moderate to severe disease.