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Malundo AFG, Abad CLR, Salamat MSS, Sandejas JCM, Poblete JB, Planta JEG, Morales SJL, Gabunada RRW, Evasan ALM, Cañal JPA, Santos JA, Manto JT, Mercado MEP, Rojo RD, Ornos EDB, Alejandria MM. Predictors of mortality among inpatients with COVID-19 infection in a tertiary referral center in the Philippines. IJID Regions 2022; 4:134-142. [PMID: 35854825 PMCID: PMC9281405 DOI: 10.1016/j.ijregi.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 01/08/2023]
Abstract
Mortality data were comparable to those of early reports relating to the wild-type SARS-CoV-2. Clinical and laboratory monitoring is critical during the 2nd to 3rd week of illness. Common and inexpensive laboratory tests may aid in the monitoring of patients. Clinical pathways can be adapted to local data, especially in resource-poor settings.
Objectives The aim of this study was to determine the predictors of mortality and describe laboratory trends among adults with confirmed COVID-19. Methods The medical records of adult patients admitted to a referral hospital with COVID-19 were retrospectively reviewed. Demographic and clinical characteristics, and laboratory parameters, were compared between survivors and non-survivors. Predictors of mortality were determined by multivariate analysis. Mean laboratory values were plotted across illness duration. Results Of 1215 patients, 203 (16.7%) had mild, 488 (40.2%) moderate, 183 (15.1%) severe, and 341 (28.1%) critical COVID-19 on admission. In-hospital mortality was 18.2% (0% mild, 6.1% moderate, 15.8% severe, 47.5% critical). Predictors of mortality were age ≥ 60 years, COPD, qSOFA score ≥ 2, WBC > 10 × 109/L, absolute lymphocyte count < 1000, neutrophil ≥ 70%, PaO2/FiO2 ratio ≤ 200, eGFR < 90 mL/min/1.73 m2, LDH > 600 U/L, and CRP > 12 mg/L. Non-survivors exhibited an increase in LDH and decreases in PaO2/FiO2 ratio and eGFR during the 2nd–3rd week of illness. Conclusion The overall mortality rate was high. Predictors of mortality were similar to those of other reports globally. Marked inflammation and worsening pulmonary and renal function were evident among non-survivors by the 2nd–3rd week of illness.
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Malundo AFG, Abad CLR, Salamat MSS, Sandejas JCM, Planta JEG, Poblete JB, Morales SJL, Gabunada RRW, Evasan ALM, Cañal JPA, Santos JA, Manto JT, Rojo RD, Ornos EDB, Severino MEL, Mercado MEP, Alejandria MM. Clinical characteristics of patients with asymptomatic and symptomatic COVID-19 admitted to a tertiary referral centre in the Philippines. IJID Reg 2022; 2:204-211. [PMID: 35721425 PMCID: PMC8818128 DOI: 10.1016/j.ijregi.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 11/06/2022]
Abstract
Asymptomatic infection is common. Bimodal age distribution of coronavirus disease 2019 (COVID-19) was observed at the University of the Philippines–Philippine General Hospital. Universal testing impacts infection control measures in resource-limited settings. Further blood testing is likely to be unnecessary for mild and asymptomatic cases of COVID-19. Symptom-based isolation protocol reduces length of hospitalization.
Objectives To describe the clinical profile and outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19) across the spectrum of disease severity. Methods This retrospective study included adult patients with confirmed COVID-19 infection admitted to a referral hospital. Descriptive statistics, tests for trend, Kaplan–Meier curve and log-rank test were used to compare characteristics and outcomes across disease severity categories. Results Of 1500 patients with COVID-19, 14.8% were asymptomatic, 13.5% had mild disease, 36.6% had moderate disease, 12.3% had severe disease and 22.7% had critical disease. Asymptomatic patients were admitted for a concurrent condition or for isolation. Patients aged >60 years, male gender and with co-morbidities had more severe disease. Fever, cough, shortness of breath, malaise, gastrointestinal symptoms and decreased sensorium were more common in patients with severe disease. Bilateral pulmonary infiltrates were common (51.1%), with sicker patients having more abnormal findings. The overall mortality rate was 15.1%. Adopting a symptom-based strategy reduced the length of hospitalization from a median of 13 [interquartile range (IQR) 7–21] days to 9 (IQR 5–14) days. Conclusion The clinical profile and outcomes for this cohort of patients with COVID-19 was consistent with published reports. Asymptomatic infection was common, and universal testing may be a valuable strategy in the correct context, given the implications for infection control. A symptom-based strategy was found to reduce the length of hospitalization considerably.
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Affiliation(s)
- Anna Flor G Malundo
- Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Cybele Lara R Abad
- Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Maria Sonia S Salamat
- Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Joanne Carmela M Sandejas
- Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Jose Eladio G Planta
- Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Jonnel B Poblete
- Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Shayne Julieane L Morales
- Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Ron Rafael W Gabunada
- Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Agnes Lorrainne M Evasan
- Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Johanna Patricia A Cañal
- Department of Radiology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Julian A Santos
- Department of Radiology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Jeffrey T Manto
- Department of Radiology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Raniv D Rojo
- College of Medicine, University of the Philippines, Manila, Philippines
| | | | | | - Maria Elizabeth P Mercado
- Department of Clinical Epidemiology, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | - Marissa M Alejandria
- Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
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