Demographic and clinical features of discharged versus death patients with COVID-19: Bangladesh perspective.

Demographic and clinical features of discharged versus death patients with COVID-19


Introduction
COVID-19 pneumonia is a public health emergency of international concern. It causes millions of deaths both in developed and underdeveloped countries. Thousands of researches are going on to assess the risk factors for mortality. In Bangladesh, thousands of people already died due to COVID-19 infection.  pneumonia is now a major burning issue and a top priority in public health worldwide due to its devastating impact on human life and the economy. An outbreak of viral pneumonia with an unidentified etiology was announced in Wuhan, China, on December 12, 2019.  discharged and 200 death cases were selected from the list by systematic random sampling following inclusion criteria. Patients with tested positive for COVID-19 pneumonia by RT-PCR (Reverse transcription polymerase chain reaction) method were included in this study. Moreover, patients who died after admission at KGH were considered death cases, but data were included only from the cases whose legal guardians consented.

Data collection
A structured questionnaire was used to gather data in this study. The objective and nature of the study were explained, and the discharged cases and the legal guardian of deceased subjects carried out written or verbal consent. Data on discharged and dead cases were collected from the patient case history file of KGH using the hospital register book. All authors had access to the collection and preserving participants' information during or after data collection. The study was conducted with the utmost support of the hospital authority.

Questionnaire design
The structured questionnaire was pre-validated by two independent reviewers. The questionnaire comprised several segments: 1. Socio-demographic information of the discharged and dead   Regarding co-morbid diseases, our study revealed that among the dead cases, 63.5 % suffered from more than one disease, whereas 36.5 % of the respondents had no or only one condition.
However, among the discharged instances, 58 % suffered from more than one co-morbid disease, and there was no or one co-morbid disease among 42 % of the respondents. The study revealed that the duration of homestays of COVID-19 patients was significantly associated with their co-morbid conditions, both in discharged (p = 0.012) and dead (p = 0.01) cases. COVID-19 discharged cases were staying at home for more than ten days (56 %) with the co-morbid disease more than one, whereas fewer co-morbid groups (3.50 %) found to spend less time (< 10 days) at home compared to those subjects who had more than 1 co-morbid diseases (2.0 %). Among the dead cases, both groups with comorbidity status (No/ <1 co-morbid disease: 34.5%; > 1 co-morbid disease: 52 %) were found to have stayed at home more than 10 days before hospital admission. Moreover, patients with more co-morbid diseases were found higher to stay at home rather than take early hospital treatment.
Our study discovered that COVID-19 patients had better outcomes with fewer homestays overall. Among the risk factors, co-morbid conditions like HTN, diabetes mellitus, ischemic heart disease, chronic kidney disease, and chronic respiratory disease play a pivotal role in mortality and morbidity incidence in COVID-19 patients. In this study, we try to find a demographic profile with clinical features and the association of other risk factors with the co-morbid disease condition among COVID-19 dead and discharged patients.
The study was done at a COVID-dedicated tertiary hospital -Kurmitola General Hospital. It was a retrospective observational study. It included a total of 400 patients with COVID-19.
Retrospectively information was collected from 200 discharged patients admitted to the hospital due to COVID-19 and from 200 patients who died from COVID-19 in the same hospital. Among the discharged cases, the majority (70 %) of the respondents were above 60 years, whereas only (30 %) were up to 60 years. In the case of death cases, 64.5 % of respondents were above 60 years, whereas 34.5 % were up to 60 years. In several previous studies, older age was found as a potential risk factor for death among COVID-19 patients. Regarding co-morbid diseases, the study revealed that among the dead cases, 63.5 % suffered from more than one disease, whereas 36.5%of the respondents had no or only one condition. However, among the discharged instances, 58 % suffered from more than one co-morbid disease, and there was no or one co-morbid disease among 42% of the respondents. Several independent studies also found an association between mortality among COVID-19 patients and increased chronic diseases such as (cardiac, renal, liver, kidney, and lung). [13,14] The study found a significant association of age range among COVID-19 patients with co-morbid conditions in both the discharged (p=0.03) and dead (p=0.01) cases. Out of 200 terminated points, respondents had more than one co-morbid disease condition (40 %, n=80/200) and belonged to the > 60-year age group. In the case of death cases, it was significantly found that respondents from the > 60- year age group had more than one co-morbid disease condition (45.5 %, n=91/200) in the highest manner compared to the counters.
The study revealed that the duration of homestays of COVID-19 patients was significantly associated with their co-morbid conditions, both in discharged (p = 0.012) and dead (p = 0.01) cases. COVID-19 discharged cases were staying at home for more than ten days (56 %) with the co-morbid disease more than one, whereas fewer co-morbid groups (3.50 %) found to spend less time (< 10 days) at home compared to those subjects who had more than 1 co-morbid diseases (2.0 %). Among the dead cases, both groups with co-morbidity status (No/ < 1 co-morbid disease: 34.5 %; > 1 co-morbid disease: 52 %) were found to have stayed at home more than 10 days before hospital admission. Moreover, patients with more co-morbid diseases were found to remain at home rather than take early hospital treatment. Our study discovered that COVID-19 patients had better outcomes with fewer homestays overall. Delayed admission to the hospital is a risk factor for COVID-19 mortality shown in other studies. [15] Our study analysis also observed a significant association between the nutritional status of COVID-19 patients and their co-morbid conditions in both discharged (p=0.001) and death (p=0.004) cases.
To explore the discharged patients, significant respondents, 50.5 % were found malnourished with more than one co-morbid disease, whereas, among the dead cases, 46.5 % were underweight. On the other hand, among the discharged instances, 30 % were found malnourished with no or one co-morbid disease, whereas 19.5 % of the respondents were underweight with no co-morbid illness.
Illustrating the outcome, we can conclude that skinny people were the most vulnerable group in both discharged and dead cases of COVID-19. It was found that obese patients with COVID-19 had a higher risk of dying compared to nonobese patients. Consistent results were found in several studies. [15,16]

Conclusion
The study aimed to understand the epidemiological situations of discharged and dead COVID-19 patients, essential for policy making and strengthening the healthcare system. There are distinctions in demographic profiles and clinical features between diseased and discharged patients of Covid -19 were found. The study revealed that the senior adult group, malnourished people, and who had more than one co-morbidity were more vulnerable and sufferers. Moreover, COVID-19 patients with more than one co-morbidities and delayed hospitalization exaggerated the disease's severity, and more deaths occurred among them. So, we concluded from our study results that aged malnourished patients with co-morbidities, who stayed at home for long periods before hospitalization, and obese patients were notably reported as death cases. The outcomes of this study suggest that aged, malnourished COVID-19 patients with co-morbidities should be handled carefully in home and hospital settings with needed facilities. Awareness should be built among people using mass media.
Furthermore, health professionals can conduct training highlighting the proper handling of those patients.