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1. Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19

Author

Balram Bhargava, Ashish Sharma, Rajnish Joshi, Amit Patel, Deepak Kumar, Ashish Pathak, Sudhir Bhandari, Manoj Kumar Panigrahi, Prasanta Raghab Mohapatra, Aparna Mukherjee, Pankaj Bhardwaj, Priyanka Ghosh, Gunjan Kumar, Simmi Dube, Nehal M Shah, Hemang M Purohit, Vikas Suri, Arti D Shah, Alka Turuk, Akhil Dhanesh Goel, Manoj Kumar Gupta, Ritin Mohindra, Ashish Bhalla, Star Pala, Balkishan Gupta, Damodar Sahu, Sourin Bhuniya, Abhishek Agrawal, Samiran Panda, Deepak Jain, Arunansu Talukdar, Janakkumar R Khambholja, Nikita Sharma, Geetha R Menon, Subhasis Mukherjee, Puspender Misra, Lokesh Kumar Sharma, Samita S, Himadri Das, Debasis Sarkar, Soumyadeep Ghosh, Moumita Dutta, Shreetama Chakraborty, Tridip Dutta Baruah, Pankaj Kumar Kannauje, Arvind Kumar Shukla, Nitesh Shah, Mary John, Kiranpreet Kaur, Vijay Nongpiur, Sachin K Shivnitwar, Bobba Rohil Krishna, Naveen Dulhani, Jigyasa Gupta, H K Aggarwal, Parshwa Naik, Manisha Panchal, Mayank Anderpa, Nyanthung Kikon, Christina Nzani Humtsoe, Rajaat Vohra, Lipilekha Patnaik, Jagdish Prasad Sahoo, Arun Kokane, Yogiraj Ray, Kruti Rajvansh, Arun Madharia, Neha Shrivastava, Sushila Kataria, Mohammad Shameem, Nazish Fatima, Saumitra Ghosh, Avijit Hazra, Himanshu D, Veeresh B Salgar, Santosh Algur, Kala Yadhav M L, Pavan Kumar M, and Mendu Vishnu Vardhana Rao

Subjects
Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Abstract

Introduction The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities.Methods Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020–October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting.Results Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30–60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6–7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03).Conclusion Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.

Published
2023
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2. Analysis of predictors and outcomes of COVID-19 patients requiring ICU admission from COVID 19

Author

Kamal Kajal, Karan Singla, Goverdhan Dutt Puri, Ashish Bhalla, Aparna Mukherjee, Gunjan Kumar, Alka Turuk, Madhumita Premkumar, Varun Mahajan, Thrilok Chander Bingi, Pankaj Bhardwaj, Mary John, Geetha R Menon, Damodar Sahu, Samiran Panda, Vishnu Vardhan Rao, Rajarao Mesipogu, Mohammed Ayaz Mohiuddin, Vinaya Sekhar Aedula, Manoj K Gupta, Akhil D Goel, Vikas Loomba, Maria Thomas, U K Ojha, R R Jha, Veeresh Salgar, Santosh Algur, Ashish Pathak, Ashish Sharma, Manju Purohit, Himanshu Dandu, Amit Gupta, Vivek Kumar, Lisa Sarangi, Mahesh Rath, Tridip Dutta Baruah, Pankaj Kumar Kannauje, Ajit Kumar, Rajnish Joshi, Saurabh Saigal, Abhishek Goel, Janakkumar R Khambholja, Amit Patel, Surabhi Madan, Nitesh Shah, V K Katyal, Deepinder Singh, Sandeep Goyal, Arti Shah, Amit Chauhan, Bhavesh Patel, Kala Yadhav M L, Dayananda V P, Chetana G S, Anita Desai, Manisha Panchal, Mayank Anderpa, Payal Tadavi, Sourin Bhuniya, Manoj Kumar Panigrahi, Shakti Kumar Bal, Sachin K Shivnitwar, Prajakta Lokhande, Srikanth Tripathy, Vijay Nongpiur, Star Pala, Md Jamil, Bal Kishan Gupta, Jigyasa Gupta, Rashmi Upadhyay, Saurabh Srivast, Simmi Dube, Preksha Dwivedi, Rita Saxena, Mohammed Shameem, Nazish Fatima, Shariq Ahmed, Nehal M. Shah, Soumitra Ghosh, Yogiraj Ray, Avijit Hazra, Arunansu Talukdar, Naveen Dulhani, Nyanthung Kikon, Subhasis Mukherjee, Susenjit Mallick, Lipilekha Patnaik, Sudhir Bhandari, Abhishek Agrawal, Rajaat Vohra, Nikita Sharma, Rajiv Kumar Bandaru, Mehdi Ali Mirza, Jaya Chakravarty, Sushila Kataria, Ratnamala Choudhury, Soumyadip Chatterji, and M.Pavan Kumar

Abstract

BackgroundSevere Corona virus disease (COVID-19) is associated with high mortality. Although single centre intensive care units (ICU) have reported clinical characteristics and outcomes, no large scale multicentric study from India has been published. The present retrospective, multi-centre study was aimed to describe the predictors and outcomes of COVID-19 patients requiring ICU admission from COVID-19 Registry of Indian council of Medical Research (ICMR), India.MethodsProspectively collected data from multiple participating institutions was entered in the electronic National Clinical Registry of COVID 19. We enrolled patients aged>18 years with COVID-19 pneumonia requiring ICU admission between March 2020 and August 2021. Exclusion criteria were negative RT PCR, death within 24 hours of ICU admission, or patients with incomplete data in the registry Their demographic characteristics, laboratory variables, ICU severity indices, treatment strategies and outcomes were analysed.ResultsA total of 5865 patients, with mean age 56±15 years, with 3840/5865 (65.4%) men, were enrolled in the ICMR registry.. Overall mortality was 2535/5865 (43.5%). Non-survivors were older than survivors (58.2±15.4 years vs 53.6 ±14.7 years; P=0.001). Non-survivors had multiple comorbidities (n=1951, 52.9%) with hypertension (47.2%) and diabetes (45.6%) being the most common, higher creatinine (1.6 ± P=0.001, high D-dimer (1.56 vs 1.37, P=0.001), higher CT severity index (16.8±5.2 vs 13.5 ±5.47 ) compared to survivors. Non survivors had longer hospital and ICU stay (P=0.001). On multivariate regression analysis, high NLR (HR 1.017, 95% CI 1.005- 1.029, P=0.001), high CRP (HR 1.008, 95% CI 1.006- 1.010, P=0.001), high D dimer ((HR 1.089, 95% CI 1.065- 1.113, P=0.001) were associated with mechanical ventilation while younger age, (HR 0.974, CI 0.965-0.983, p=0.001), high D dimer (HR-1.014, CI 1.001-1.027, P=0.035) and use of prophylactic LMWH (HR 0.647, CI 0.527-0.794, p=0.001) were independently associated with mortality. ConclusionIn this large retrospective study of 5865 critically ill COVID 19 patients admitted to ICU, overall mortality was 2535/5865 (43.5%). Age, high D dimer, CT Severity score and use of prophylactic LMWH were independently associated with mortality.

Published
2022

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