Research Article

Effect of Systemic Illness and Comorbidities in the Prognosis of Severe Acute Respiratory Illness Patients: An Observational Study


Background: Globally critically ill COVID-19 (Coronavirus disease-19) patients have stretched critical care services. This study was undertaken to find factors implicated in mortality amongst COVID positive and negative patients presenting with severe acute respiratory illness (SARI) and factors having the probability of indicating COVID positivity.
Methods: The demographic parameters, comorbid illness, clinical parameters and laboratory values of 327 patients were retrospectively analyzed to find the risk factors for mortality in COVID positive and negative patients and factors predicting COVID positivity amongst SARI patients.
Results: 58% of SARI patients tested positive by RTPCR. Most common comorbidities were diabetes and hypertension, 35.2% and 33% respectively. Duration of swelling and low haemoglobin were significantly associated with mortality in COVID positive group (p=0.01, 0.005). Acidosis and tachycardia (p=0.003, 0.034) were associated with mortality amongst COVID negative. Creatinine, Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) were higher in non-survivors of both groups (p<0.001). Age, history of contact or from containment zone, cough, pain abdomen and P/F ratio were significant predictors of COVID positivity (1.020(1.006–1.035); 3.889(1.316–11.495); 2.908(1.182–7.152); 2.147(1.149–4.012); 0.997(0.994-1.000) respectively) by multivariable regression analysis.
Conclusion: A long duration of swelling and low haemoglobin (<12 g%) were responsible for COVID positive mortality while pain abdomen, raised levels of AST, tachycardia and acidosis were associated with mortality in COVID negative. Deranged creatinine, higher SOFA and qSOFA were associated with mortality in both groups. Age, contact history, residence in containment zone, cough, pain abdomen and poor P/F ratio are predictive factors for COVID positivity.

[1] Gebru AA, Birhanu T, Wendimu E, Ayalew AF, Mulat S, Abasimel HZ, et al. Global public health significances, health care perception of community, treatments, prevention and control methods of Coronavirus Disease 2019 Outbreak. Hum Antibodies. 2021;29(2):129-137.
[2] Blumenthal D, Fowler EJ, Abrams M, Collins SR. Covid-19 - Implications for the Health Care System. N Engl J Med. 2020; 383(15):1483-1488.
[3] Kasthuri A. Challenges to Healthcare in India - The Five A's. Indian J Community Med. 2018; 43(3):141-143.
[4] Gandhi PA, Kathirvel S. Epidemiological studies on coronavirus disease 2019 pandemic in India: Too little and too late? Med J Armed Forces India. 2020; 76(3):364-365.
[5] Fitzner J, Qasmieh S, Mounts AW, Alexander B, Besselaar T, Briand S, et al. Revision of clinical case definitions: influenza-like illness and severe acute respiratory infection. Bull World Health Organ. 2018; 96(2):122-8.
[6] Tambe MP, Parande MA, Tapare VS, Borle PS, Lakde RN, Shelke SC. An epidemiological study of laboratory-confirmed COVID-19 cases admitted in a tertiary care hospital of Pune, Maharashtra Indian J Public Health. 2020; 64(6):183.
[7] Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229):1054-62.
[8] Agarwal N, Biswas B, Lohani P. Epidemiological determinants of COVID-19 infection and mortality: A study among patients presenting with severe acute respiratory illness during the pandemic in Bihar, India. Niger Postgrad Med J. 2020; 27(4):293.
[9] Xie J, Wu W, Li S, Hu Y, Hu M, Li J, et al. Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study. Intensive Care Med. 2020; 46(10):1863-72.
[10] Aggarwal A, Shrivastava A, Kumar A, Ali A. Clinical and epidemiological features of SARS-CoV-2 patients in SARI ward of a tertiary care centre in New Delhi. J Assoc Physicians India. 2020; 68(7):19-26.
[11] Mazumder A, Arora M, Bharadiya V, Berry P, Agarwal M, Behera P, et al. SARS-CoV-2 epidemic in India: epidemiological features and in silico analysis of the effect of interventions. F1000Research. 2020; 9:315.
[12] A Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020; 55(5).
[13] Espinosa OA, Zanetti AD, Antunes EF, Longhi FG, Matos TA, Battaglini PF. Prevalence of comorbidities in patients and mortality cases affected by SARS-CoV2: a systematic review and meta-analysis. Rev Inst Med Trop Sao Paulo. 2020;62.
[14] Prasad N, Gopalakrishnan N, Sahay M, Gupta A, Agarwal SK. Epidemiology, genomic structure, the molecular mechanism of injury, diagnosis and clinical manifestations of coronavirus infection: An overview. Indian J Nephrol. 2020; 30(3):143-154.
[15] Batlle D, Soler MJ, Sparks MA, Hiremath S, South AM, Welling PA, et al. Acute kidney injury in COVID-19: emerging evidence of a distinct pathophysiology. J Am Soc Nephrol. 2020; 31(7):1380-3.
[16] Ng CY, Squires TJ, Busuttil A. Acute abdomen as a cause of death in sudden, unexpected deaths in the elderly. Scott Med J. 2007; 52(1):20-3.
[17] Kåreholt I, Brattberg G. Pain and mortality risk among elderly persons in Sweden. Pain. 1998; 77(3):271-8.
[18] Zou X, Li S, Fang M, Hu M, Bian Y, Ling J, et al. Acute physiology and chronic health evaluation II score as a predictor of hospital mortality in patients of coronavirus disease 2019. Crit Care Med. 2020; 48(8):e657.
[19] Liu S, Yao N, Qiu Y, He C. Predictive performance of SOFA and qSOFA for in-hospital mortality in severe novel coronavirus disease. Am J Emerg Med. 2020; 38(10):2074-80.
[20] Jones AE, Trzeciak S, Kline JA. The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med. 2009; 37(5):1649.
[21] Zhang L, Li J, Zhou M, Chen Z. Summary of 20 tracheal intubation by anesthesiologists for patients with severe COVID-19 pneumonia: retrospective case series. J Anesth. 2020; 34(4):599-606.
[22] Bezuidenhout MC, Wiese OJ, Moodley D, Maasdorp E, Davids MR, Koegenlenberg CF, et al. Correlating arterial blood gas, acid–base and blood pressure abnormalities with outcomes in COVID-19 intensive care patients. Ann Clin Biochem. 2021; 58(2):95-101.
[23] Cen Y, Chen X, Shen Y, Zhang XH, Lei Y, Xu C, et al. Risk factors for disease progression in patients with mild to moderate coronavirus disease 2019—a multi-centre observational study. Clin Microbiol Infect. 2020; 26(9):1242-7.
[24] Giacomelli A, Ridolfo AL, Milazzo L, Oreni L, Bernacchia D, Siano M, et al. 30-day mortality in patients hospitalized with COVID-19 during the first wave of the Italian epidemic: a prospective cohort study. Pharmacol Res. 2020; 158:104931.
[25] Taneri PE, Gómez-Ochoa SA, Llanaj E, Raguindin PF, Rojas LZ, Roa-Díaz ZM, et al. Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis. Eur J Epidemiol. 2020; 35(8):763-73.
[26] Yang X, Jin Y, Li R, Zhang Z, Sun R, Chen D. Prevalence and impact of acute renal impairment on COVID-19: a systematic review and meta-analysis. Crit Care. 2020; 24(1):356.
[27] Gheorghe G, Ilie M, Bungau S, Stoian AM, Bacalbasa N, Diaconu CC. Is There a Relationship between COVID-19 and Hyponatremia?. Medicina. 2021; 57(1):55.
[28] De La Flor Merino JC, Valga F, Biscotti B, Marschall A, Rodeles del Pozo M. Hyponatremia in COVID-19 infection: possible causal factors and management. J Allergy Infect Dis. 2020;1(3):53-6.
[29] Hu W, Li C, Xu Y, Qi Y, Zhang Z, Li M, et al. Disorders of sodium balance and its clinical implications in COVID-19 patients: A multicenter retrospective study. Intern Emerg Med. 2021; 16:853-62.
IssueVol 9 No 2 (2023): Spring QRcode
SectionResearch Article(s)
Coronavirus COVID-19 Respiratory failure SARI SARS-CoV-2

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How to Cite
Khurana D, Choudhury A, Manisha M, Mitra Mustafi S, Uppal V, Khurana H, Sachdeva H, Gupta N, Ganpathy U. Effect of Systemic Illness and Comorbidities in the Prognosis of Severe Acute Respiratory Illness Patients: An Observational Study. Arch Anesth & Crit Care. 2023;9(2):84-95.