Management of Patients With COVID-19 During the Pandemic: A Retrospective Cohort Study From a Tertiary Care Centre in Mumbai, India

Abstract

Introduction: We conducted the present analysis to understand the clinical outcomes in patients with COVID-19 infection and the factors associated with mortality over the one-and-a-half years of the pandemic in Mumbai, India.

Methods: This is a retrospective cohort study of 3561 COVID-19 patients admitted to a private tertiary care hospital in Mumbai, India. The main outcome variable for analysis was death (yes/no). We compared the characteristics of COVID-19 patients who had died during their stay in the hospital with those who had not died. We used survival analysis to identify the factors associated with mortality.

Results: The mortality rate was 0.71 per 100 person-days (95% CI: 0.61-0.81 per 100 person days (PD)); it was higher (2.03 (95% CI: 1.47, 2.82) per 100 PD) in those aged >= 80 years compared with 18-39 years (p<0.001). The hazard rate (HR) was significantly higher in those with chronic liver disease (HR: 5.12, 95% CI: 1.78, 14.71; p=0.002) and lower in those who were treated with injection enoxaparin (HR: 0.46, 95% CI: 0.31, 0.69; p<0.001). In patients without breathing difficulties, the hazard was significantly lower in those treated with doxycycline (HR: 0.41, 95% CI: 0.17, 0.99; p=0.05). In patients who presented with breathing difficulties, hazard was significantly lower in those who were treated with remdesivir (HR: 0.52, 95% CI: 0.31, 0.90; p=0.019). In patients who required ventilatory support (invasive and non-invasive), the hazard was significantly lower with injected tocilizumab (HR: 0.56, 95% CI: 0.36, 0.89; p=0.013).

Conclusions: The mortality was highest during the initial days of the pandemic and in patients with co-morbidities. Remdesivir and the tocilizumab injection were useful in the reduction of mortality in the severe form of COVID-19 infection. Doxycycline was useful in milder and less severe forms of infection. However, enoxaparin injection was associated with lower mortality in most of these cases.

Keywords: clinical experience; cohort; covid-19; doxycycline; enoxaparin; mortality; remdesivir; tocilizumab.

Figure 1. Total number of cases and percentage of deaths in 3561 patients with COVID-19 admitted to a tertiary care hospital in Mumbai, India

Figure 2. Total number of cases and oxygen requirement in 3561 patients with COVID-19 admitted to a tertiary care hospital in Mumbai, India

Figure 3. Kaplan-Meier survival curves in 3561 patients admitted with COVID-19 in a tertiary care hospital according to age groups (A) and gender (B) in Mumbai, India

Figure 4. Kaplan-Meier survival curves in 3561 patients admitted with COVID-19 in a tertiary care hospital according to presentation with breathing difficulties in Mumbai, India

Figure 5. Kaplan-Meier survival curves in 3561 patients admitted with COVID-19 in a tertiary care hospital with diabetes mellitus (comorbidity) in Mumbai, India

Figure 6. Kaplan-Meier survival curves in 3561 patients admitted with COVID-19 in a tertiary care hospital with hypertension (comorbidity) in Mumbai, India

Figure 7. Kaplan-Meier survival curves in 3561 patients admitted with COVID-19 in a tertiary care hospital with chronic kidney disease (comorbidity) in Mumbai, India

Figure 8. Kaplan-Meier survival curves in 3561 patients admitted with COVID-19 in a tertiary care hospital according to oxygen requirement in Mumbai, India

VS-NIV: noninvasive ventilation; VS-invasive

Figure 9. Hazard ratio for various treatment modalities according to clinical presentation (breathing difficulties) in 3561 COVID-19 patients in Mumbai, India

Figure 10. Hazard ratio for various treatment modalities according to oxygen requirement in 3561 COVID-19 patients in Mumbai, India