The clinical course of COVID-19 in the outpatient setting: a prospective cohort study (original) (raw)
Related papers
A Clinical Monitoring Program of COVID-19 Outpatients: A Prospective Cohort Study
Canadian Journal of Infectious Diseases and Medical Microbiology
Purpose. Coronavirus disease 2019 (COVID-19) has been associated with a high rate of mortality and morbidity. While a high portion of COVID-19 patients have mild symptoms, a limited number of clinical trials have evaluated the clinical course of this large group of patients. This study was designed to investigate the demographics and clinical characteristics and comorbidity of nonhospitalized COVID-19 patients. Methods. This prospective, observational cohort study was performed on nonhospitalized adult patients (≥18 years) with COVID-19. Pharmacotherapy service was responsible for patients’ assessment for up to 1 month. Demographic characteristics, the onset of symptoms, severity, duration, laboratory data, and hospitalization rate were evaluated by a pharmacist-based monitoring program. Results. From 323 patients who had been referred to the emergency department, 105 individuals were recruited between April 26 and August 2, 2020. Most of the patients were female (66.7%) with a mean...
Diseases, 2021
COVID-19 has a devastating impact worldwide. Recognizing factors that cause its progression is important for the utilization of appropriate resources and improving clinical outcomes. In this study, we aimed to identify the epidemiological and clinical characteristics of patients who were hospitalized with moderate versus severe COVID-19 illness. A single-center, retrospective cohort study was conducted between 3 March and 9 September 2020. Following the CDC guidelines, a two-category variable for COVID-19 severity (moderate versus severe) based on length of stay, need for intensive care or mechanical ventilation and mortality was developed. Data including demographic, clinical characteristics, laboratory parameters, therapeutic interventions and clinical outcomes were assessed using descriptive and inferential analysis. A total of 1002 patients were included, the majority were male (n = 646, 64.5%), Omani citizen (n = 770, 76.8%) and with an average age of 54.2 years. At the bivaria...
Results: We included a total of 375 patients with 60.27% being male. Thepredominant symptoms were fever (86.4%), cough (68.53%), and fatigue/myalgia (38.13%) and other symptoms including dyspnea,chest pain, and sore throat. We also found patients with GI symptoms like diarrhea (8.53%) and nausea/vomiting (44.53%).Comorbidities were found in 162 (42.2%) patients with the most common being hypertension (23.73%) followed by diabetesmellitus (13.07%).At admission, 56.37% presented with lymphopenia and 36.27% had elevated D-dimers. Severe-critical patients were 5.06% with a median time from onset to critical disease of 8.5 days. 24% of the patients required oxygen therapy. The case fatality rate was 1.6% with median time from onset to death of 16 days. Conclusion: Patients with coexisting comorbidities are at higher risk and need more utilization of health care resources. As this virus is spreading globally, all countries have to join hands and prepare at all levels of human resources, infrastructure, and facilities to combat the COVID-19 disease.
International Journal of Infectious Diseases, 2021
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. Clinical characteristics and outcomes of hospitalized COVID-19 patients in a MERS-CoV referral hospital during the peak of the pandemic
Paripex Indian Journal Of Research, 2021
Background and Objectives: Since its first official identification in December 2019, the COVID-19 pandemic emerged as possibly the most critical public health emergency the world has ever faced. After the brunt of the first wave in 2020, as the world was gradually limping back to normalcy, the second wave hit and hit hard. In this study we have studied the clinical characteristics of the patients with COVID-19 admitted to a tertiary care hospital in NorthEast India during the second wave. Materials And Methods: In this observational study, the clinical characteristics and outcomes of patients admitted to a tertiary care hospital at Guwahati, Assam, India, from April 23 to May 31, 2021 were analyzed. All patients were diagnosed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) on throat and/or nasopharyngeal swabs. The admitted patients were managed as per Government of Assam protocol for management of COVID-19. Results And Observations: In this study we have enrolled 691 patients. The history of contact with COVID-19-affected individuals was available in 145 (20.98%) patients. The age group most commonly affected was 51-79 years with a mean age of 61.7 years and the males (64.5 %) were predominantly affected. Of the study population, 82% were symptomatic. The most common symptoms were fever (67 %), cough ((34 %), breathlessness ((37%), and 61 % patients had hypoxia (SpO2<94%) on admission. Past history of COVID-19 infection was documented in 7 patients and 18 patients had received first dose of COVID vaccine (COVISHIELD) and 2 patients received second dose also. Associated medical or surgical conditions were present in 361(52.24%) patients, diabetes and hypertension being the commonest. Shifting to intensive care unit (ICU) was needed in 75 patients (10.9%), and 93 (13.5%) patients were shifted to post-covid ward after testing negative for COVID-19. 33 (4.8%) patients opted for home isolation after remaining stable for minimum 3 days. Mortality of 2.7 per cent (19 patients) was recorded in the study. The mean SPO2 in room air at the time of admission was 85.02 in the discharged group, 77.1 in the expired group, 78.3 in those shifted to ICU, 77.8 in the shifted to post-covid ward group and 94.8 in those who opted for home isolation. The mean duration of symptoms at the time of admission was 3.3 days in the discharged group, 6.6 days in the expired group, 3.6 days in those shifted to ICU, 4.1 days in the shifted to post-covid ward group and 3.6 days in those who opted for home isolation. Conclusion: A considerable population (n=276, 39.9%) of the patients included in our study group were elderly (51-79 years) and symptomatic (82%). 67 % of the patients had fever, 61% had respiratory symptoms and 17% had gastrointestinal symptoms. Patients with comorbidities and low SPO2 on presentation, older age group (mean 68.1) had poor outcome. Longer duration of symptoms prior to hospitalization was associated with higher mortality in this study.
Cureus, 2022
Background Many international studies have reported the outcomes and predictors of coronavirus disease 2019 (COVID-19); however, only a few national studies have reported predictors of poor outcomes among adult hospitalized patients with COVID-19. Therefore, this study aimed to describe the clinical characteristics and complications of COVID-19 and identify predictors of poor outcomes. Methods This was a retrospective cohort study. All adult patients confirmed with COVID-19 who were admitted at the King Abdulaziz Medical City (KAMC)-Jeddah between March 1, 2020, and December 31, 2020, were included; pediatric and pregnant patients were excluded. The clinical features and complications of COVID-19 were tested for association with poor outcomes (intensive care unit [ICU] admission or death) using chi-square and Fisher's exact tests. In addition, logistic regression analysis was performed to identify the predictors of poor outcomes. Results A total of 527 patients were included in this study. Forty-two patients (8%) (6-10, 95% confidence interval [CI]) died: 13 in the general wards and 29 in the ICU. Of the 84 patients admitted to the ICU, 65 underwent invasive mechanical ventilation. Poor outcome affected 97 patients (18%) (15-22, 95% CI). Shortness of breath, oxygen saturation <92%, and abnormal chest x-ray findings were associated with poor outcomes (Pvalue < 0.001). In addition, lymphocyte counts were significantly lower, while c-reactive protein levels were significantly higher among patients with poor outcomes (P-value < 0.001). The most common complications were acute cardiac (83 patients, 16%), acute kidney (78 patients, 15%), and liver injuries (76 patients, 14%). Predictors of poor outcome were the updated Charlson comorbidity index (CCI) (odds ratio [OR] 1.2 [95% CI 1.1-1.4]), liver injury (OR 2.6 [95% CI 1.3-4.9]), acute kidney injury (OR 4.3 [95% CI 2.3-7.8]), and acute cardiac injury (OR 5.1 [95% CI 2.8-9.4]). Conclusions COVID-19 disease is associated with significant morbidity and mortality. Predictors of poor outcomes among COVID-19 hospitalized patients were the updated CCI, liver injury, acute kidney, and acute myocardial injuries. Subsequently, the risk of poor COVID-19 outcomes is increased among patients with multiple comorbidities and/or multiple COVID-19 complications.
JAMA, 2020
; and the Northwell COVID-19 Research Consortium IMPORTANCE There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19). OBJECTIVE To describe the clinical characteristics and outcomes of patients with COVID-19 hospitalized in a US health care system. DESIGN, SETTING, AND PARTICIPANTS Case series of patients with COVID-19 admitted to 12 hospitals in New York City, Long Island, and Westchester County, New York, within the Northwell Health system. The study included all sequentially hospitalized patients between March 1, 2020, and April 4, 2020, inclusive of these dates. EXPOSURES Confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample among patients requiring admission. MAIN OUTCOMES AND MEASURES Clinical outcomes during hospitalization, such as invasive mechanical ventilation, kidney replacement therapy, and death. Demographics, baseline comorbidities, presenting vital signs, and test results were also collected. RESULTS A total of 5700 patients were included (median age, 63 years [interquartile range {IQR}, 52-75; range, 0-107 years]; 39.7% female). The most common comorbidities were hypertension (3026; 56.6%), obesity (1737; 41.7%), and diabetes (1808; 33.8%). At triage, 30.7% of patients were febrile, 17.3% had a respiratory rate greater than 24 breaths/minute, and 27.8% received supplemental oxygen. The rate of respiratory virus co-infection was 2.1%. Outcomes were assessed for 2634 patients who were discharged or had died at the study end point. During hospitalization, 373 patients (14.2%) (median age, 68 years [IQR, 56-78]; 33.5% female) were treated in the intensive care unit care, 320 (12.2%) received invasive mechanical ventilation, 81 (3.2%) were treated with kidney replacement therapy, and 553 (21%) died. As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital. The median postdischarge follow-up time was 4.4 days (IQR, 2.2-9.3). A total of 45 patients (2.2%) were readmitted during the study period. The median time to readmission was 3 days (IQR, 1.0-4.5) for readmitted patients. Among the 3066 patients who remained hospitalized at the final study follow-up date (median age, 65 years [IQR, 54-75]), the median follow-up at time of censoring was 4.5 days (IQR, 2.4-8.1). CONCLUSIONS AND RELEVANCE This case series provides characteristics and early outcomes of sequentially hospitalized patients with confirmed COVID-19 in the New York City area.
Severity of Disease and COVID-19 Complications During Hospital Stay: A Prospective Cohort Study
Archives of Iranian Medicine
Background: COVID-19, with its high transmission and mortality rates and unknown outcomes, has become a major concern in the world. Among people with COVID-19, severe cases can quickly progress to serious complications, and even death. So, the present study aimed to examine the relationship between the severity of the disease and the outcome in patients afflicted by COVID-19 during hospitalization. Methods: A total of 653 patients with COVID-19 aged 18 years or older were included from Khorshid hospital in Isfahan, Iran and followed for a mean of 22.72 days (median 23.50; range 1–47). Severe COVID-19 was defined by respiration rate≥30 times/min, oxygen saturation level≤88% in the resting position, and pulse rate≥130/min. The primary outcome was mortality. The secondary outcomes included need for mechanical ventilation and intensive care unit (ICU) admission. Results: During 4233 person-days of follow-up, 49 (7.5%) deaths, 27 (4.1%) invasive ventilation and 89 (13.6%) ICU admissions ...
Clinical features and outcomes of hospitalized COVID-19 patients in a low burden region
2020
Data on the clinical features and outcomes of COVID-19 patients from countries with low disease burden are rare. Greece, however, presented a low burden of COVID-19 disease during the first pandemic outbreak. This is a retrospective study of COVID-19 hospitalized patients in Greece. Clinical data were extracted from medical records using univariable and multivariable logistic regression analysis to assess the factors associated with ICU admission and in-hospital death. Eighty five patients were included in this study, 49 (57.7%) male with median (25th-75th) age 60 (49-72) years old. Sixty-one (72%) of them had at least one comorbidity with hypertension being the most common (45,6%). More than half (56%) had severe or critical disease, 20% required ICU care (14% received invasive ventilation) and 10.7% died. Solid tumor (p=0.021) and NEWS score (p=0.048), thrombocytopenia (p=0.036) or involvement of all lung fields in chest x-ray (p=0.002) on admission were independent risk factors o...
Early impact of the COVID-19 pandemic on in-person outpatient care utilisation: a rapid review
BMJ Open
ObjectivesTo quantitatively assess the early impact of the COVID-19 pandemic on in-person outpatient care utilisation worldwide, as well as across categories of services, types of care and medical specialties.DesignRapid review.MethodA search of MEDLINE and Embase was conducted to identify studies published from 1 January 2020 to 12 February 2021, which quantitatively reported the impact of the COVID-19 pandemic on the amount of outpatient care services delivered (in-person visits, diagnostic/screening procedures and treatments). There was no restriction on the type of medical care (emergency/primary/specialty care) or target population (adult/paediatric). All articles presenting primary data from studies reporting on outpatient care utilisation were included. Studies describing conditions requiring hospitalisation or limited to telehealth services were excluded.ResultsA total of 517 articles reporting 1011 outpatient care utilisation measures in 49 countries worldwide were eligible...