Clinical Profile and Outcome of Critically-ill Hospitalized COVID-19 Patients Aged 18-50 Years: A Limited Resource Setting Perspective

• Published in: Journal of the Association of Physicians of India Vol. 71; no. 12; p. 24
• Main Authors: Shastri, Minal, Vekaria, Raj, Raval, Darshankumar Manubhai, Mallik, Shashwat, Khan, Shahin
• Format: Journal Article
• Language: English
• Published: India 01.12.2023
• Subjects: Adenosine Monophosphate - analogs & derivatives; Adolescent; Adult; Alanine - analogs & derivatives; Antibodies, Monoclonal, Humanized; Comorbidity; COVID-19 - complications; COVID-19 - epidemiology; COVID-19 - therapy; Critical Illness; Female; Ferritins - blood; Fibrin Fibrinogen Degradation Products - analysis; Hospitalization; Humans; India - epidemiology; Male; Middle Aged; Prospective Studies; Respiration, Artificial; Risk Factors; SARS-CoV-2; Young Adult; India
• ISSN: 0004-5772
• DOI: 10.59556/japi.71.0354

The coronavirus disease of 2019 (COVID-19) pandemic started by affecting the older age groups with comorbidities but gradually advanced to severely affect even young adults. This study attempts to clinically evaluate critically ill young and middle-aged adults hospitalized with COVID-19 and study the association of risk factors and the markers of inflammation and coagulation with their outcome. A prospective observational study on 146 patients was conducted in a tertiary care hospital in Western India. History taking, clinical examination, laboratory investigations, and chest X-rays were done for all patients, and investigations were repeated after 3 days. Treatment, including ventilation, was given according to standard guidelines. Difficulty in breathing was the most common chief complaint, and the majority of patients had a normal body temperature on admission. Involvement of >2 lung zones on chest X-ray, a high neutrophil to lymphocyte (N/L) ratio, the presence of complications, raised D-dimer and serum ferritin, and invasive ventilation were all associated with higher mortality. While the presence of a single comorbidity did not affect the outcome, a combination of multiple comorbidities increased the mortality. The presence of multiple comorbidities and complications along with radiological abnormalities and raised D-dimer and serum ferritin are associated with critically ill COVID-19 patients and may indicate a higher risk of mortality. Administration of remdesivir has no significant influence on the outcome, but tocilizumab decreases the mortality. The inflammatory markers scoring system has utility in the prognosis of patients, especially in limited-resource settings.