Clinical profile of hospitalised moderate category COVID-19 patients: Short study from a Tertiary Care Centre in Delhi

Abstract

Background: The clinical profile of hospitalized moderate-category COVID-19 patients has been understudied globally and in India.

Aim: The present study was conducted to study the clinical profile and assess the proportions of patients who progressed to severe disease and its predictors among moderate COVID-19 patients.

Materials and methods: In this single-center observational study, 100 moderate-category COVID-19 patients as per Ministry of Health and Family Welfare (MoHFW) criteria of age ≥18 years of either sex, excluding pregnant females from February to November 2021, were studied by analyzing their clinical profiles and assessing Quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score 2 (NEWS-2), and chest computed-tomography severity score (CTSS) to predict progression to severe disease. Severe disease was defined as per MoHFW criteria.

Results: Out of 100 moderate-category COVID-19 patients, progression to severe disease was seen in 11 patients (11%), among which eight patients had expired, three patients were discharged, and the rest of the 89 patients (89%) who did not progress to severe disease were discharged. A higher age (62.2± 19.5 vs 54.8 ± 14.6 years), along with multivariate analysis revealing male sex (1.25 times), chronic kidney disease (2.86 times), leukocytosis (6.10 times), thrombocytopenia (1.04 times), anemia (9.3 times), a higher qSOFA score (3.6 times), and a higher NEWS-2 score on admission (1.56 times) had higher odds of progression to severe disease. A significant correlation (P < .05) of qSOFA score with serum LDH, ferritin, and hs-CRP levels; CT severity score with the serum ferritin, IL-6, and LDH levels; and NEWS-2 with serum LDH, hs-CRP, and ferritin levels were found. Moreover, the NEWS-2 score was found slightly better than qSOFA on receiver operating characteristic (ROC) curve analysis, with an area under the curve of 85.8% and 83.2%, respectively, predicting progression to severe disease.

Conclusion: Our study revealed male gender, chronic kidney disease, leukocytosis, anemia, thrombocytopenia, a higher qSOFA and NEWS-2 score on admission, and further, NEWS-2 score better than qSOFA on ROC curve analysis, with an area under the curve of 85.8% and 83.2%, respectively, in predicting severe disease among hospitalized moderate COVID-19 patients.

Keywords: CTSS score; MoHFW COVID-19 criteria; NEWS-2; inflammatory markers; moderate category COVID-19; qSOFA.

Figure 1

Based on the AUC analysis of the ROC curve, it was seen that the NEWS-2 score with an AUC of 85.8% was slightly better than the qSOFA score, which had an AUC of 0.832 or 83.2%. The results for both these scores were significant statistically. The qSOFA score and NEWS-2 score were the best modalities for predicting the progression to severe disease

Figure 2

Scatter Diagram (a) qSOFA score and CTSS were positively and significantly correlated with each other (Pearson r - 0.31, 95% confidence interval - 0.12 to 0.48, R squared - 0.094, P (two-tailed) - 0.0020, P and lt; 0.05). (b) Similarly, qSOFA and NEWS-2 scores were positively and significantly correlated with each other (Pearson r - 0.85, 95% confidence interval - 0.78 to 0.90, R squared - 0.72, P (two-tailed) and lt; 0.0001, P and lt; 0.05)