Clinical characteristics and treatment outcomes of severe (ICU) COVID-19 patients in Saudi Arabia:

Clinical characteristics and treatment outcomes of severe (ICU) COVID-19 patients in Saudi Arabia: A single-center study


Background

There is limited information describing the presenting features and treatment outcomes of intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19) in Saudi Arabia.


Objective

To investigates the clinical, epidemiological, laboratory, radiological, vital signs, and treatment characteristics/outcomes of severe (ICU) COVID-19 patients in Albaha region, Saudi Arabia.


Methods

A retrospective cohort study was conducted from 01 April 2020 to 31 August 2020 involving a files review of 171 patients admitted to the ICU of a COVID-19 treatment center as a result of severe symptoms.



Results

Around a third of the ICU patients admitted were over 66 years of age, 59.6% males, 45% diabetics, 39% hypertensive, 25.7% smokers. Patients had symptoms such as 79% fever, 78% cough, 75% headache, 59% sore throat, 57% runny nose, and 75% cough. More than half of the patients had <90% oxygen saturation. Bilateral infiltration was present in about 43% of patients. 85.4% lymphopenia and 70.8% D-dimer (>0.5 u/ml) were the most significant laboratory results. The median stay in the hospital ranged from 4 to 15.6 days, and the ICU time ranged from 4 to 12.7 days. Approximately 29% of patients received antiviral, antimalarial, and antibiotic treatment, while 27.5% of patients received antibiotics and antimalarial therapy alone. Incorporating hydroxychloroquine in treatment protocols did not improve patients’ outcomes.


Conclusions

Older age and cardio-metabolic comorbidities increase the risks of severe COVID-19. Different treatment protocols fail to improve mortality rates and urgent efforts are required to prevent the disease and reduce its severity.


Introduction

Globally, there are 109,555,318 confirmed cases of COVID-19 as of February 17, 2021, including 2,420,451 deaths (World Health Organization, 2020). The first confirmed case was registered in Saudi Arabia on 2 March 2020. From 2 March to 17 February 2021, there are 373,702 confirmed cases of COVID-19 with 6445 deaths (Saudi Ministry of Health, 2020). Saudi Arabia has a population of 34,218,169 of which 497,068 people live in the Albaha region (General Authority for Statistics, 2019).

Due to the different demographics, comorbidities, and response of the immune system in the various populations, the seriousness of the disease appears variable. Pneumonia may be the most frequent manifestation of acute respiratory distress syndrome (ARDS). Other serious complications have been reported, including arrhythmia, septic shock, and multi-organ failure (Arentz et al., 2020, Chen et al., 2020). Older persons with comorbidities and polypharmacy have a higher risk for drugs interactions, side effects, complications, and a high probability of viral infection (Hammad et al., 2020, Hammad et al., 2019b, Hammad et al., 2019a, Hammad et al., 2017, Mangi et al., 2020).

Although numerous studies reported on the epidemiology and typical presentation of COVID-19 patients in Saudi Arabia (Alsofayan et al., 2020, Alyami et al., 2020, Shabrawishi et al., 2020), regional data is still needed to improve emergency response planning and optimize the use of healthcare resources.

This study aims to investigate the clinical, epidemiological, laboratory, radiological, vital signs, and treatment characteristics/outcomes of severe (ICU) COVID-19 patients in the Albaha region, Saudi Arabia.


2. Methods

A retrospective cohort study was conducted from 01 April 2020 to 31 August 2020 involving a files review of 171 patients admitted to the ICU of a COVID-19 treatment center in the Albaha region as a result of severe symptoms. A list of all COVID-19 patients admitted to the ICU was obtained from the medical administration. Of those patients, 171 patients had a confirmed COVID-19 infection and were included in the study. Patients were confirmed as having the virus by positive SARS-CoV-2 nucleic acid results using a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay on nasopharyngeal swab specimens. A data collection form was developed as an Excel file to facilitate the data collection process that was done manually by trained hospital pharmacists that were trained by the investigator on how to collect the data from the hospital electronic medical records system. Demographics, laboratory, clinical, radiological, and medication data were collected. Descriptive statistics were used for data analysis. Ethical approval was obtained from the Scientific and Research Committee at the hospital taking part in this study.


2.1. Statistical analysis

The data were expressed as an average value of ±SD value (standard deviation). Using SPSS software (version 20) to compare variables in the best protocols and co-morbidities, a one-way ANOVA statistical analysis was performed. To analyze categorical data, the X2 test was implemented. To detect the relationship between the categorical variables, the Chi-square test was also used to compare the clinical features between patients with or without diabetes and with or without hypertension. The length of stay from the date of admission to the discharge/transfer date was recorded for all included patients. The median (IQR) length of stay is presented in tables (3&5). The Kruskal-Wallis analysis was used to compare the medians. P values were considered statistically significant if below 0.05.




3. Results

About 32% of the admitted patients for ICU were above 65 years old, 60% males, 45% diabetic, 39% hypertensive, 26% smokers. The patients had symptoms as 79% fever, 78% cough, 75% headache, 59% sore throat, and 57% runny nose. More the half of the patients had oxygen saturation <90%. About 43% of patients had bilateral infiltration as described in Table 1. The most important laboratory findings were 85.4% lymphopenia, 70.8% D-dimer (>0.5 u/ml), 44.4% neutrophilia, and 41% eosinophilia as illustrated in Table 2. The length of hospital stay ranged from 4 to 15.6 days and the time in ICU ranged from 4 to 12.7 days as presented in Table 3. About 29% of the patients were prescribed antiviral, antimalarial, and antibiotics therapy, and unfortunately 35% of those patients died. Around 27.5% of patients were prescribed antibiotics and antimalarial only, of which 13% passed away as shown in Table 4. We did not collect data on the factors affecting the choice of the treatment protocol, but the rationale for choosing triple therapy, the most aggressive protocol, was mainly based on the severity of patients’ symptoms and clinicians’ attempt, at the time, to kill the virus and reduce the damage it was causing in those severely ill patients. We observed no difference in the mortality rate between the protocol of therapy with or without hydroxychloroquine (P-value: 0.625) as described in Table 5. The most prescribed medications were Paracetamol, Ceftriaxone, Azithromycin, Hydroxychloroquine, Enoxaparin, Omeprazole, vitamin D, Zinc, Methylprednisolone, and Dexamethasone as prescribed in Table 6.


Conclusion

The pathogenesis and etiology of COVID-19 remain unknown to date, and targeted therapies for COVID-19 patients are not yet available, except empirically symptomatic therapies for critically ill patients. Scientists around the world should work together to find successful COVID-19 therapies. Understanding patients' demographics and characteristics of COVID-19 presentation should feed into efforts for disease prevention. Sales of antibiotics and hydroxychloroquine | Hydroxychloroquine (Plaquenil) | Facts about chloroquine and hydroxychloroquine | get rx for hydroxychloroquine | hydroxychloroquine get you high | Hydroxychloroquine Uses | Side Effects of Plaquenil (Hydroxychloroquine) | Hydroxychloroquine tablets |

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