Covid-19 caused by the novel SARS CoV2 is a devastating pandemic of the twenty-first century. As early as 2019, with the first case reports from Wuhan, China, it was found that the mortality parameters varied from region to region and was influenced by geographical and ethnic factors. Age, comorbidities, cultural and socio-economic factors influenced the outcome in severe COVID-19 infection.¹ Earlier reported studies showed wide variability in the mortality rate across regions, and it varied from 1% to 12% in different geographical areas. Studies have shown that elderly patients and those with comorbidities like diabetes and hypertension had higher mortality. India, which has the second-highest population in the world, was one of the countries badly affected with 3.43 crores infected cases and 4.5 lakhs deaths by the first week of November 2021.²

Most patients infected with SARS-CoV-2 are asymptomatic or present with an uncomplicated mild illness characterized by fever, dry cough, myalgia, nausea, asthenia, and diarrhoea. Up to 14% of patients, however, can evolve toward the development of a severe respiratory disease, characterized by interstitial pneumonia and progressively worsening respiratory impairment requiring ventilatory assistance.³ About 5% of patients ultimately develop a full-on severe acute respiratory distress syndrome (SARS), requiring an intensive care unit (ICU) admission. These patients are also at risk of developing sepsis, septic shock, metabolic acidosis, coagulopathy, and multiorgan failures, such as liver, kidneys, and heart.⁴

Clinical status, in particular peripheral oxygen saturation (SpO2) levels, and concurrent comorbidities of COVID-19 patients largely determine the need for their admittance to ICUs, laboratory diagnosis can be of great help in the definitive diagnosis. The decision to test for SARS-CoV-2 infection should be based on both clinical and epidemiological factors.⁵

The demographic characteristics, comorbid conditions association, presentation of clinical features, and outcomes of patients with COVID-19 have been reported variable in different countries in various studies therefore, it is important to analyze and document these in the local population. This study aims to describe the demographics, clinical characteristics and outcomes among COVID-19 patients.

Setting: The study was conducted at Department of General Medicine, Jawaharlal Nehru Medical College (KLE University), Belagavi.

Duration and type of study: A retrospective study was conducted for a period of six months from September 2020 to February 2021.

Sampling methods: All continuous samples which satisfy inclusion criteria were taken for study.

Inclusion criteria: All clinically suspected patients tested positive for COVID-19 by RT PCR.

Exclusion criteria: Insufficient reported data information of COVID-19 patients excluded from the study.

Data collection procedure: Nasal and oropharyngeal swabs (of clinically suspected COVID-19 patients) sent in viral transport media (VTM ) in cold chain to the Department of Microbiology, Molecular laboratory BMCH Chitradurga was immediately tested for COVID-19 RT-PCR qualitative assay on Quant-studio Real-time thermocycler system. The CT (cycle threshold cut-off) value and amplification curve were observed and the result was expressed as positive or negative. All required details of RTPCR positive COVID-19 patients admitted in COVID care Centre i.e Demographic characters, comorbid conditions, clinical features, laboratory tests, radiological reports, treatment and outcome data were extracted from the hospital medical records section and analyzed.

After reviewing the guidelines of various international societies and revised national clinical management guidelines for COVID-19 by the Ministry of Health and Family Welfare (MOHFW), Government of India, 13 June 2020 a standard protocol was devised which included case definitions for SARS-CoV-2 infection Categorization, baseline and follow up investigations and treatment plan according to clinical severity by a group of experts from various specialties of BMCH Chitradurga.

Study groups: Based on the burden of comorbid illness, clinical, laboratory and radiological characters COVID-19 patients were grouped as asymptomatic and symptomatic patients and evaluated. Asymptomatic cases- patients without positive CT findings (or with positive CT findings but no symptoms).

The severity of symptomatic COVID‑19 was assessed as per the MOHFW guidelines, Government of India as mild, moderate and severe cases.

Mild cases were those COVID‑19 patients who had uncomplicated upper respiratory tract infection with no evidence of hypoxia and breathlessness

Moderate cases were those with radiological and clinical features of pneumonia with SpO2 in the range of 90%–94%, with a respiratory rate of more or equal to 24 breaths per minute

Severe cases were those who were meeting any of the following criteria: respiratory distress with respiratory rate ≥30/min and oxygen saturation ≤90% at rest or respiratory rate ≥24 breaths per minute along with features of sepsis and septic shock.

Ethical consideration & permission: Ethical clearance for this study was obtained from the institutional ethical clearance committee.

Statistical Analysis: Categorical variables were represented as frequency and percentage, and continuous variables were seen as the median and interquartile range (IQR) using Microsoft Excel and Statistical Package for the Social Sciences (SPSS).

Data from 684 RTPCR positive COVID-19 patients admitted to COVID care Centre BMCH were analyzed in our study retrospectively.

The mean age of all patients was 38.9 years (± 12.5 SD). 340(49.6%) patients were between 18-45years, 240 (35.1%) were between 46-60 years and 104(15.2%) were aged above 60 years. Males (59.3%) were higher than females (40.6%). No comorbidities were observed in 502(73.3%) patients. Co-morbidities of the patients observed are Hypertension in 134(19.5%), diabetes in 119 (17.3%), COPD in 42(6.1%), chronic kidney disease in 17 (2.4%) and chronic liver disease in 9 (1.3%) patients. Of the 684 COVID-19 patients, 361(52.9%) were asymptomatic, 322(47.2%) were symptomatic, 144 (21.1%) patients had intensive care unit (ICU) admission, 542(79.2%) cured from COVID-19 and discharged and 95(13.6%) cases had mortality.

Table 1: Demographic features, Clinical findings and Outcome of COVID-19 patients (n= 684)

Table 2: Clinical and laboratory characteristics

Since the outbreak of COVID-19 in Wuhan, China, it has rapidly spread around the world. The first case of COVID19 in India was reported on 30 January 2020 originating from China. The prevalence of COVID-19 infection was increased daily in India and also among different countries in the world. Thus, the need to assess the pattern of clinical and demographic characteristics, disease severity, management and mortality required to limit the pervasiveness of this pandemic. In this retrospective study, we attempted to interpret the distinct demographic characteristics, risk factors, laboratory markers associated with the severity and fatality of COVID-19 patients.⁶ Our findings in the study revealed the lower mean age of patients (38.9± 12.5 SD, year) compared to previously published reports (42-47 year) from other authors and slight male preponderance, Soni S L et al also reported a similar age pattern in their study. In our study more asymptomatic (52.9%) patients at admission were seen compared to symptomatic (47.2%) patients. Most symptomatic patients had mild respiratory symptoms such as nasal symptoms, throat irritation and cough and only a small portion of them had dyspnea, Xu X et al  also reported similar findings in their study. Fever was present in 81 per cent of our patients, Which was comparable to other reports across the globe. The study conducted by Jain P et al is focused on the early part of the COVID-19 pandemic, the most common presenting complaints were fever, cough, and breathlessness.⁷

Fever was the most common symptom noted in around 80% of the patients, breathlessness was observed in 74.2% of the severe COVID patients and 59.4% of the nonsevere COVID patients (P = 0.21). Our study findings correlate with these results. An increase in non-respiratory symptoms like diarrhoea and vomiting was seen in some of the other studies. However, our data did not reflect any such clinical findings.⁸ In our study Patients aged 45-59 years were noted to have associated with more than one comorbidity. Increased incidence of severe COVID-19 disease associated with underlying comorbidities such as hypertension, diabetes, chronic liver and kidney diseases. Similar findings have been reported from many other studies.⁹

Highly elevated levels of inflammatory markers (CRP, Ferritin, LDH) were noted among patients with underlying comorbidities as compared to those without comorbidities. Panagiotis Paliogiannis et al and Elena Aloisio et al also reported comparable laboratory test results. Ferritin and CRP are acute-phase proteins that may reflect the hyper inflammatory state induced by SARS-CoV-2 active infection, LDH activity in serum may reflect both lung damage and more widespread tissue damage.¹⁰

Our study findings demonstrated that asymptomatic COVID-19 patients have better outcomes than symptomatic patients. This may have been due to more active cellular immune responses and normal liver function. Since asymptomatic patients have no clinical symptoms which can easily prevent timely diagnosis and treatment, they may cause a greater risk of virus transmission than symptomatic patients, which poses a major challenge to infection control. Patients with comorbidities were more vulnerable to disease severity and critical condition.

We observed many variations in COVID-19 patient’s characteristics. Regarding the clinical features, fever remained the most common symptom in the first wave. Old age, diabetes, hypertension, chronic liver disease and chronic kidney disease tended to have higher disease severity. Our results add to the growing literature that inflammatory markers are elevated in those with severe illness and indicated a risk of mortality. Inflammatory markers such as CRP, serum ferritin, and NLR may be used to predict disease severity, especially in resource-limited settings where other markers such as IL‑6 and troponin -I are not affordable or have limited availability.

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