European Journal of Cardiovascular Medicine

In December 2019, an outbreak of a novel coronavirus, later named SARS-CoV-2, was reported in Wuhan, China. This virus quickly spread across the globe, leading to a pandemic of unprecedented scale, now known as COVID-19. The pandemic has significantly impacted global health, with over 1 billion confirmed cases and a high mortality rate, particularly among critically ill patients requiring intensive care (1). COVID-19 is the third coronavirus to emerge in the human population in the last two decades, following the severe acute respiratory syndrome coronavirus (SARS-CoV) outbreak in 2002 and the Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in 2012 (2,3).

The clinical presentation of COVID-19 varies widely, ranging from mild symptoms to severe respiratory failure requiring mechanical ventilation. The most common symptoms include fever, cough, and dyspnea, with a subset of patients developing acute respiratory distress syndrome (ARDS), multi-organ failure, and death (4). Mortality rates have varied globally, influenced by factors such as healthcare capacity, patient demographics, and comorbid conditions (5). In India, which is the second most populous country in the world, COVID-19 has resulted in over 10 million confirmed cases and more than 150,000 deaths as of early 2021. The state of Madhya Pradesh reported over 2.5 lakh cases, with Vidisha district recording 3,761 cases and 71 deaths (6).

The overburdening of healthcare facilities, especially intensive care units (ICUs), has been a significant challenge during the pandemic. In resource-limited settings, delays in hospital presentation and lack of adequate medical infrastructure have exacerbated the mortality associated with COVID-19. The current study aims to describe the clinical profile and outcomes of critically ill COVID-19 patients admitted to the COVID ICU at Atal Bihari Vajpayee Government Medical College, Vidisha, Madhya Pradesh. To the best of our knowledge, this is the first study of its kind conducted in this region, providing valuable insights into the clinical course and outcomes of these patients.

Study Design

This study was a retrospective observational study conducted at Atal Bihari Vajpayee Government Medical College (ABVGMC), Vidisha, Madhya Pradesh, India. The study focused on critically ill patients with confirmed COVID-19 infection who were admitted to the COVID ICU at ABVGMC from September 2020 to December 2020.

Study Population

The study population included all critically ill COVID-19 patients admitted to the COVID ICU during the study period. The inclusion criteria were as follows:

• Inclusion Criteria:
• Patients aged 18 years and above.
• Positive COVID-19 diagnosis confirmed by reverse transcription-polymerase chain reaction (RT-PCR) using oropharyngeal or nasopharyngeal swabs.
• Patients classified as critically ill based on the following criteria:
• Respiratory rate > 30 cycles/min.
• Resting tachycardia > 120/min.
• Hypotension (BP < 90/60 mmHg).
• Oxygen saturation (SpO2) < 95%.
• Exclusion Criteria:
• Pregnant or breastfeeding women.
• Patients with known allergies to any study-related medications.

Data Collection

Data were collected retrospectively from the medical records of patients who met the inclusion criteria. The following data points were recorded:

• Demographic Information: Age, gender, and comorbidities.
• Clinical Characteristics: Symptoms on admission, vital signs, and laboratory findings (including CBC, CRP, ESR, D-Dimer, Serum Ferritin, IL-6, RFT, and LFT).
• Treatment Details: Type and duration of respiratory support, medications administered, and any invasive procedures performed.
• Outcomes: Length of ICU stay, duration of mechanical ventilation, development of complications (e.g., ARDS, acute kidney injury), and final outcomes (recovery or death).

Operational Definitions

• Date of Disease Onset: Defined as the day when the first symptom was noticed by the patient.
• Fever: Defined as an axillary temperature of 37.5°C or higher.
• Lymphocytopenia: Defined as a lymphocyte count of less than 1500 cells per cubic millimeter.
• Thrombocytopenia: Defined as a platelet count of less than 150,000 per cubic millimeter.
• Acute Respiratory Distress Syndrome (ARDS): Defined according to the Berlin definition (1).
• Acute Kidney Injury (AKI): Defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria (2).

Statistical Analysis

All data were analyzed using SPSS software 23. Quantitative variables were presented as mean ± standard deviation (SD), median, and range, while categorical variables were presented as frequencies and percentages. The comparison of categorical variables between groups was performed using the chi-square test. For continuous variables, comparisons were made using the Student's t-test if normally distributed. A p-value of less than 0.05 was considered statistically significant.

Ethical Considerations

The study protocol was reviewed and approved by the Institutional Ethics Committee of ABVGMC, Vidisha. As the study was retrospective, informed consent was not required from the patients; however, confidentiality and data protection measures were strictly adhered to. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Demographic and Clinical Characteristics

A total of 150 critically ill COVID-19 patients were included in the study. The mean age of the patients was 58 ± 12 years, with the majority being male (65%). The most common comorbidities were hypertension (45%) and diabetes mellitus (38%). Table 1 provides a summary of the demographic and clinical characteristics of the study population.

Table 1: Demographic and Clinical Characteristics of Study Population

Laboratory Findings

The laboratory findings showed that 55% of the patients had lymphocytopenia, and 60% had elevated D-dimer levels. Other notable laboratory abnormalities included elevated CRP in 70% of patients and elevated IL-6 levels in 50% of patients. The detailed laboratory findings are presented in Table 2.

Table 2: Laboratory Findings on Admission

Treatment and Outcomes

The majority of patients (80%) required some form of respiratory support, with 50% needing invasive mechanical ventilation. The mean duration of ICU stay was 12 ± 5 days. The overall mortality rate in the ICU was 35%, with the remaining patients either recovering or continuing to receive care. Table 3 summarizes the treatment modalities and outcomes of the patients.

Table 3: Treatment Modalities and Outcomes

Factors Affecting Outcomes

A subgroup analysis revealed that factors such as older age, presence of comorbidities (especially hypertension and diabetes), and elevated levels of inflammatory markers (e.g., CRP, D-dimer, IL-6) were significantly associated with poor outcomes, including higher mortality rates. The relationship between these factors and patient outcomes is summarized in Table 4.

Table 4: Factors Affecting Mortality

* Statistically significant at p < 0.05.

These results indicate that critically ill COVID-19 patients with advanced age, comorbidities, and elevated inflammatory markers are at a higher risk of adverse outcomes, including death.

The COVID-19 pandemic has posed unprecedented challenges to healthcare systems worldwide, with a particular focus on the management of critically ill patients in intensive care units (ICUs). In our study, we aimed to describe the clinical profile and outcomes of critically ill COVID-19 patients admitted to a tertiary care center in central India, specifically at Atal Bihari Vajpayee Government Medical College, Vidisha. The results of this study provide valuable insights into the factors associated with poor outcomes in this patient population.

Our findings indicate that the majority of critically ill COVID-19 patients were male and had comorbid conditions such as hypertension and diabetes mellitus, which aligns with previous studies that have identified these factors as significant predictors of severe disease and mortality (1,2). The mean age of patients in our study was 58 years, which is consistent with other studies that have reported older age as a significant risk factor for adverse outcomes in COVID-19 patients (3).

The most common symptoms on admission were dyspnea, fever, and cough, which are characteristic of severe COVID-19 and have been widely reported in the literature (4). Laboratory findings in our study revealed that a substantial proportion of patients had lymphocytopenia, elevated D-dimer, and elevated C-reactive protein (CRP) levels, all of which have been associated with severe disease and poor prognosis (5,6). Elevated IL-6 levels were also observed in a significant number of patients, reflecting the hyperinflammatory state often seen in critically ill COVID-19 patients (7).

The mortality rate in our study was 35%, which is within the range reported by other studies involving critically ill COVID-19 patients in ICUs (8). The high mortality rate underscores the severe impact of COVID-19 on critically ill patients and highlights the importance of early identification and aggressive management of those at higher risk of poor outcomes.

Our subgroup analysis identified several factors associated with increased mortality, including older age, the presence of comorbidities (particularly hypertension and diabetes), and elevated levels of inflammatory markers such as CRP, D-dimer, and IL-6. These findings are consistent with previous research, which has demonstrated that patients with these characteristics are more likely to experience severe disease and poor outcomes (9,10). The significant association between elevated inflammatory markers and mortality suggests that the hyperinflammatory response in COVID-19 plays a crucial role in the progression to severe disease and death.

The strengths of our study include the comprehensive analysis of clinical and laboratory data from a well-defined cohort of critically ill COVID-19 patients. However, there are several limitations to consider. First, the study's retrospective design may introduce biases related to data collection and missing information. Additionally, the study was conducted at a single center, which may limit the generalizability of the findings to other settings. Further multi-center studies are needed to confirm these results and explore potential interventions to improve outcomes in this patient population.

In conclusion, our study provides important insights into the clinical profile and outcomes of critically ill COVID-19 patients in central India. The identification of key risk factors for poor outcomes, such as older age, comorbidities, and elevated inflammatory markers, can aid in the early recognition and management of high-risk patients. Future research should focus on strategies to mitigate these risk factors and improve the survival of critically ill COVID-19 patients.

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