Vaccination saves lives: How do patients with chronic diseases and severe COVID-19 fare? Analysis from India’s National Clinical registry for COVID-19 (original) (raw)
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QJM: An International Journal of Medicine
ObjectivesThis study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalized coronavirus disease 2019 (COVID-19) adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC).MethodsNCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined.ResultsAnalysis of 29 509 hospitalized, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18 752 (63.6%)] showed that 15 678 (53.1%) had at least one comorbidity. Among 25 715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n = 3957). Adjusted odds of dying were significantly higher in age group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy and tuberculos...
Background: Vaccination has been recommended to curve the COVID-19 pandemic. Associations of death among COVID-19 patients with their COVID-19 vaccination status and various co-morbidities are ill understood. Objectives: To compare the proportions of death between COVID-19 vaccinated and un-vaccinated and to determine the association of vaccination status and selected co-morbidities with death among COVID-19 patients treated in the DCH of Tripura. Materials and Methods: This secondary data based cross-sectional study was conducted in the DCH of Agartala Government Medical College using medical records of 2354 COVID-19 patients treated during second and third quarters of 2021, chosen by simple random sampling. A pre-designed proforma was used to extract data regarding demographics, vaccination status, co-morbidities, vitals, treatment outcome etc. from the case-sheets. Binary regression model was utilized for predicting the probability of death due to COVID-19 using important predictor variables. Result: Majority i.e. 68% patients were aged between 18 to ≤60 yr, 56.7% were male, 38.3% had comorbidities, 11% received single dose, 9.6% received two doses and 79.4% had no COVID-19 vaccination. Death rate was 5.8% among first dose recipients, 9.3% among second dose recipients and 11.4% among unvaccinated. Overall death rate was 7.4%. Binary regression model has shown that older age, poor oxygen saturation during hospitalization, chronic kidney disease, hypertension and diabetes mellitus are having significant enhancing effect and vaccination having protective effect upon death. Conclusion: Old age, diabetes mellitus, hypertension and chronic kidney disease have enhancing and vaccination has got protective effect against death due to COVID-19. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Indian Journal of Medical Research, 2021
Background & objectives: India witnessed a massive second surge of COVID-19 cases since March 2021 after a period of decline from September 2020. Data collected under the National Clinical Registry for COVID-19 (NCRC) were analysed to describe the differences in demographic and clinical features of COVID-19 patients recruited during these two successive waves. Methods: The NCRC, launched in September 2020, is an ongoing multicentre observational initiative, which provided the platform for the current investigation. Demographic, clinical, treatment and outcome data of hospitalized, confirmed COVID-19 patients were captured in an electronic data portal from 41 hospitals across India. Patients enrolled during September 1, 2020 to January 31, 2021 and February 1 to May 11, 2021 constituted participants of the two successive waves, respectively. Results: As on May 11, 2021, 18961 individuals were recruited in the registry, 12059 and 6903 reflecting in-patients from the first and second waves, respectively. Mean age of the patients was significantly lower in the second wave [48.7 (18.1) yr vs. 50.7 (18.0) yr, P<0.001] with higher proportion of patients in the younger age group intervals of <20, and 20-39 yr. Approximately 70 per cent of the admitted patients were ≥ 40 yr of age in both waves of the pandemic. The proportion of males were slightly lower in second wave as compared to the first [4400 (63.7%) vs. 7886 (65.4%), P=0.02]. Commonest presenting symptom was fever in both waves. In the second wave, a significantly higher proportion [2625 (48.6%) vs. 4420 (42.8%), P<0.003] complained of shortness of breath, developed ARDS [422(13%) vs. 880 (7.9%), P<0.001], required supplemental oxygen [1637 (50.3%) vs. 4771 (42.7%), P<0.001], and mechanical ventilation [260 (15.9%) vs. 530 (11.1%), P<0.001]. Mortality also significantly increased in the second wave [OR: 1.35 (95% CI: 1.19, 1.52)] in all age groups except in <20 yr. Interpretation & conclusions: The second wave of COVID-19 in India was slightly different in presentation than the first wave, with a younger demography, lesser comorbidities, and presentation with breathlessness in greater frequency.
Indian Journal of Critical Care Medicine
Background: Emergency authorization and approval were given for the coronavirus disease-19 (COVID-19) vaccines. The efficacy reported after phase III trials were 70.4% and 78% for Covishield and Covaxin, respectively. In this study, we aim to analyze the risk factors, which were associated with mortality in critically ill COVID-19-vaccinated patients admitted into intensive care unit (ICU). Methods: This study was conducted from April 1, 2021 to December 31, 2021 across five centers in India. Patients who had received either one or two doses of any of the COVID vaccines and developed COVID-19 were included. The ICU mortality was a primary outcome. Results: A total of 174 patients with COVID-19 illness were included in the study. The mean age was 57 years standard deviation (SD 15). Acute physiology, age and chronic health evaluation (APACHE II) score and the sequential organ failure assessment (SOFA) score were 14 (8-24.5) and 6 (4-8), respectively. Multiple variable logistic regression showed patients who have received a single dose [
Cureus, 2022
Introduction: COVID-19 vaccines have been found to be efficacious for preventing severe disease, yet breakthrough infections and deaths have occurred in a small proportion of vaccinated individuals. This study aimed to describe the vaccination status and comorbidities of COVID-19 all-cause deaths. Methods: This descriptive observational study was conducted at a tertiary care center in western India. A total of 310, RT-PCR positive COVID-19 deaths, aged 45 years and above irrespective of the cause of death (all-cause mortality), were included in the study. Death after breakthrough infection was defined as death in patient with disease onset after 14 days of the second dose of vaccine. Results: Diabetes was the most common comorbidity found in 17.1% of the deaths, followed by hypertension. Cardiovascular disease and renal disease were other common comorbidities seen in 8.7% and 4.83% deaths respectively. Other less common comorbidities include neurological disorders, HIV, autoimmune disorders. Out of these 310 deaths, 21.4% of patients developed disease within 14 days of the first dose. Death after true breakthrough infection (after 14 days of both doses) was seen in only two patients (0.6%). One of these two patients was aged 60 years and had diabetes, while the other was aged 72 years and had a history of smoking. Conclusion: Diabetes and hypertension were the most common comorbidities, indicating a higher risk of mortality among comorbid patients. Only a small proportion of deaths (0.6%) occurred after breakthrough infection beyond 14 days of two doses. COVID-19 vaccines have shown promising efficacy against severe disease, thus high vaccination coverage needs to be achieved to prevent morbidity and mortality.
Monaldi Archives for Chest Disease
Even nearly two years after the first reported case, the novel coronavirus (SARS-CoV-2) continues to ebb and flow around the world. A retrospective cohort study was carried out to determine the clinico-epidemiological profile and outcome of the cases. The study analyzed secondary data from 827 patients who presented to our center with COVID-19-related illnesses between December 15, 2021, and February 15, 2022 (third wave in India). There was a significant difference in the vaccination status of patients treated at home and those admitted, with 87.9% having received two doses compared to 74% in the second group being unvaccinated. Patients who were isolated at home recovered at a rate of 99.4%, while hospitalized patients died at a rate of 26.5%. Vaccination reduces the severity of COVID-19; however, constant vigilance for new variants, precautionary measures, and increased vaccination drives are critical moving forward. *Other members of the Safdarjung Hospital COVID-19 working gr...
Cureus
Background and objective The coronavirus disease 2019 (COVID-19) outbreak, which was first detected in Wuhan, China, has turned into a rapidly spreading global healthcare crisis. The clinical and laboratory features of COVID-19 are associated with significant regional variations. In this study, we aimed to describe the clinical and demographic profile of COVID-19 patients from a tertiary care hospital in Northeast India. Materials and methods This was a hospital-based cross-sectional study that included all laboratory-confirmed COVID-19 cases admitted to the institution from 1st July to 31st October 2020. The information was collected on a predesigned proforma, which included patients' demographic profiles, clinical presentations, and outcomes as per treatment by trained doctors. Results The study included 180 laboratory-confirmed COVID-19 cases. A history of contact with laboratoryconfirmed COVID-19-affected individuals was found in 92 (51.1%) patients. The median age of the patients was 37.17 years (range: 18-80 years), and there were 104 (57.78%) males in the cohort. Of the total enrolled patients, 102 (56.67%) were asymptomatic from the time of exposure till their admission. The common presenting complaints were fever (n=55, 70.51%), cough (n=42, 53.85%), and shortness of breath (n=32, 42.02%). The case fatality rate among the admitted cases was 15%. Comorbidities were found in 84 (46.67%) patients with the most common one being diabetes mellitus (n=31, 36.9%) followed by hypertension (n=29, 34.52%). Patients with advanced age (more than 60 years) and coexisting comorbidities were at higher risk of progression of disease and death. Conclusion The COVID-19 pandemic is not only a huge burden on healthcare facilities but also a significant cause of disruption in societies globally. The majority of the patients with COVID-19 infection presenting to our hospital were young and asymptomatic. Patients of advanced age with comorbidities were found to have more complications. An analysis of the trends related to COVID-19 in different hospital and institutional settings will help to achieve better preparedness and lead to improved patient care to combat the COVID-19 pandemic in a more efficient manner.
COVID-19 Case Fatality and Vaccination Status: A Hospital Based Cross Sectional Study
International Journal of Advanced Research
Introduction: Effectiveness of COVID-19 vaccine in preventing COVID-19 and related mortality is to be studied in depth especially now since we are on the verge of 4th wave of pandemic. The present study aims to evaluate the effectiveness of vaccines in preventing case fatality in hospitalized COVID-19 patients in a tertiary care centre. Methods: A hospital based cross-sectional study was done in all COVID-19 patients admitted in a tertiary care centre in Aurangabad from February 2021 to May 2022. 1275 patients vaccination status was known and outcome of these patients were studied. Unadjusted Odds ratios for each variable were estimated and logistic regression was used for multivariate analysis. Results: 360 study participants (28.24%) had taken at least 1 dose of vaccine, while 915 (71.76%) were not vaccinated. 441 (34.59%) participants had unfavourable outcome (death). The mortality in vaccinated was 24.17% (87/360) while it was 38.69% (354/915) in unvaccinated. In logistic regres...
medRxiv (Cold Spring Harbor Laboratory), 2022
Introduction: Long-COVID syndrome encompasses a constellation of fluctuating, overlapping systemic symptoms after COVID. We know that vaccination reduces the risk of hospitalization and death but not of re-infections. How these vaccines impact long-COVID is under debate. The current study was designed to analyze the patterns of long-COVID amongst vaccinated and unvaccinated hospitalized patients during the three waves in India. Methods: The computerized medical records of the patients admitted to a group of hospitals in the National Capital Region of Delhi with a nasopharyngeal swab positive RT-PCR for SARS-CoV-2, during the three distinct COVID-19 waves, were accessed. Because of large numbers, every 3 rd case from the data sheet for the wave-1 and wave-2 but all cases admitted during wave-3 were included because of small numbers (total 6676). The selected patients were telephonically contacted in April 2022 for symptoms and their duration of long-COVID and their vaccination status. Of these, 6056 (90.7%) responded. These were divided into fully vaccinated who received both doses of COVID vaccine at least 14 days before admission (913) and unvaccinated at the time of admission (4616). Others and deaths were excluded. "Symptom-weeks" was calculated as the sum of weeks of symptoms in case of two or more symptoms. The statistical significance was tested, and odds ratio (unadjusted and adjusted) were calculated by logistic regression. Results: Nearly 90% of COVID-19 patients reported at least one symptom irrespective of their vaccination status. Almost three-fourths of these had symptoms lasting up to a month but nearly 15% reported a duration a least 4 weeks including 11% even exceeding one year. During wave-3, significantly more vaccinated patients reported short term post-acute sequelae of COVID-19 than did All rights reserved. No reuse allowed without permission.
Cureus, 2022
Background: Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by SARS CoV-2 that emerged in Wuhan, China, and has rapidly spread worldwide. The mortality rate of critically ill COVID-19 patients is high. Objective: To assess the severity, different clinical symptoms, and comorbidities of COVID-19 pneumonia in vaccinated vs. non-vaccinated patients. Methods: In this single-center, cross-sectional study, 142 patients with COVID-19 were enrolled. The clinical characteristics, comorbidities, severity, and outcomes were also assessed. Results: Of the 142 patients, 92 (64.8%) were males, with a mean age of (56.00±14.81) years. Among them, 62 (43.7%) were aged above 60 years. Of these, 92 (64.7%) had comorbidities. The patients were divided into two groups: unvaccinated and those who received at least one dose of the vaccine within six months. The demographic characteristics of the two groups were similar except for gender. In the vaccinated group, most of the patients were males. Most patients in the non-vaccinated group had a severe illness, whereas most patients in the vaccinated group had mild to moderate disease. Only 26% of the vaccinated group experienced severe illness compared to 71.5% in the unvaccinated group. In addition, the all-cause 30-day mortality in the non-vaccinated population was higher than that in the vaccinated population. However, this difference was not statistically significant (12.5% vs. 7.1%). On the contrary, there was no difference in the length of the intensive care unit or total hospital stay between the two groups. Conclusion: Severe COVID-19 had the worst outcome in the unvaccinated patients. Most partially vaccinated patients got infected before developing immunity, and a small percentage of completely immunized patients who were infected were likely non-responders. Receiving at least one vaccination dose significantly reduced illness severity.