Factors Responsible for Severity of Infection in Coronavirus Disease 2019 Patients: A Multicenter Study

Abstract

Background & Objective: After the Spanish Flu world has seen epidemics of SARS and MERS; however, 
these epidemics have no comparison to the magnitude of devastation caused by COVID-19. This virus 
originated from Wuhan, China and spread to every nook and corner of the world within weeks. In three 
months World Health Organization had labeled it as a pandemic. This novel deadly virus shows no 
discrimination of race or age. Everyone is equally at risk of developing the infection; however, clinical 
severity is thought to be influenced by age and the presence of comorbids. Furthermore, an increased rate of 
intensive care admissions, length of stay, need for mechanical ventilation, and mortality have been reported 
in patients with COVID-19 infections having comorbids.The objective of this study was to evaluate the 
Factors responsible for clinical severity of COVID 19 infection in patients presenting to tertiary care 
hospitals 
in Lahore. 
Methods: This Descriptive observational study was conducted simultaneously at three tertiary care 
hospitals in Lahore. A total of 200 confirmed patients with COVID-19 infection by RT PCR were included in 
the study. The case records of all the inpatients in the General Corona ward, Isolation wards, HDUs and ICUs 
were analyzed. Data analysis was performed in SPSS 20. Age, gender, and comorbid including Diabetes, 
hypertension, ischemic heart disease were recorded and their relationship with the severity of COVID 19 
infection was studied by applying the Spearman's rank correlation and Fisher's exact test. 
Results: Out of the total 200 patients 54.5% were male and 45.5% were female, with a mean age of 58.29 = 
15.20 years. Critical and severe disease was seen in 33% and 63% of patients respectively. Most frequent 
comorbids reported were Hypertension (HTN), Diabetes (DM), ischemic heart disease (IHD), and lung 
diseases. A statistically significant positive association was observed between the severity of COVID 19 
infection and increased age, diabetes. Hypertension was most frequently reported comorbid but association 
was not statistically significant. However, patients who had HTN along with ischemic heart disease had a 
statistically significant positive association with the severity of the disease . 
Conclusion: Advanced age, diabetes Mellitus and hypertension when present in patients with ischemic heart 
disease have a statistically significant association with clinical severity of patients suffering from COVID 19 
infection. 
Keywords: COVID 19, Clinical Severity, Age, Comorbids, Diabetes (DM), Hypertension (HTN), Ischemic 
heart disease (IHD) .