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ORIGINAL ARTICLE
Year : 2021  |  Volume : 48  |  Issue : 3  |  Page : 156-160

Clinicopathological features and outcome of COVID-19 – Early experiences from three COVID hospitals, Chittagong, Bangladesh


1 Department of Medicine, CMOSHMC, Chittagong, Bangladesh
2 Department of Tropical Medicine, BITID, Chittagong, Bangladesh
3 Department of Medicine, Rangamati Medical College, Rangamati, Bangladesh
4 Department of Oncology, CMOSHMC, Chittagong, Bangladesh
5 Department of Medicine, Corona Isolation Unit, Chattogram Maa O Shishu Hospital Medical College, Chittagong, Bangladesh
6 Department of Medicine, Chittagong Medical College, Chittagong, Bangladesh

Date of Submission05-Apr-2021
Date of Acceptance31-May-2021
Date of Web Publication28-Dec-2021

Correspondence Address:
Dr. Rajat Sanker Roy Biswas
Department of Medicine, CMOSHMC, Agrabad, Chittagong
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_30_21

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  Abstract 


Introduction: COVID 19 is an unknown virus affecting mankind creating a deadly experience to all. It is true for Bangladesh also. So the objectives of the present study are to find the clinicopathological features and outcome of COVID patients admitted to three COVID dedicated hospitals of Chittagong, Bangladesh. Methods: This was an observational study where a total of 209 patients admitted to three COVID dedicated hospital were recruited. Clinicopathological data were recorded and patients were under observation till discharge and thus outcome were recorded. Prior consent was taken from the patients and ethical clearance was also taken. Data were compiled and analyzed by Statistical Package for Social Sciences-20. Results: Among 209 patients most of them were male 139 (66.5%) and male to female ratio was 1.98:1. Age group distribution revealed more were aggregated in the age group of 41–50 years 36 (17.2%), 51–60 years 54 (25.8%), and 61–70 years 57 (27.3%). Among all 92 (44%) patients were reverse transcription-polymerase chain reaction (RT-PCR) positive and 117 (56%) were probable cases. Fever was present in 195 (93.3%) cases, cough in 180 (86.1%), respiratory distress in 105 (50.2%) anosmia in 123 (58.8%), aguesea in 112 (53.58%) and lethargy was present in 143 (68.42%). Chest X-ray findings revealed 73 (34.9%) had bilateral patchy opacities, 20 (9.6%) had unilateral opacities 65 (31.1%) had consolidations, 6 (2.9%) had ground glass opacities, and 2 (1.0%) had pleural effusion. Supplemental O2 was given in 173 (82.8%) patients, Favipiravir in 59 (28.2%), Remdesivir in 111 (53.1%), Methylprednisolone in 87 (41.6%), Dexamethasone in 93 (44.5%), Antibiotics in 204 (97.60%), Toccilizumab in 34 (16.3%), plasma in 18 (8.6%), and low molecular weight heparin (LMWH) in 200 (95.7%) patients. Regarding outcome of the COVID patients admitted, 85 (92.4%) patients improved, 6 (6.5%) died who were RT-PCR positive and 107 (91.15%) improved, 9 (7.7%) died who were probable cases. Total death rate was 7.1%. Conclusion: The present study findings were some early activities among COVID patients in the years 2020. Male were more affected and middle age group people were the most victims.

Keywords: COVID-19, O2, outcome, remdesivir


How to cite this article:
Biswas RS, Nath JD, Barua PK, Karim MR, Jahan S, Islam MS, Ahmed KF, Kanti K. Clinicopathological features and outcome of COVID-19 – Early experiences from three COVID hospitals, Chittagong, Bangladesh. J Sci Soc 2021;48:156-60

How to cite this URL:
Biswas RS, Nath JD, Barua PK, Karim MR, Jahan S, Islam MS, Ahmed KF, Kanti K. Clinicopathological features and outcome of COVID-19 – Early experiences from three COVID hospitals, Chittagong, Bangladesh. J Sci Soc [serial online] 2021 [cited 2022 Jan 26];48:156-60. Available from: https://www.jscisociety.com/text.asp?2021/48/3/156/333842




  Introduction Top


In December 2019, a new respiratory tract infecting agent emerged in Wuhan city of China, known as the coronavirus (CoV).[1] It was later named COVID-19. COVID-19 has now become a pandemic. While the origin of the 2019-novel CoV is still being investigated, the current evidence suggests spread to humans occurred through transmission from wild animals illegally sold in the Huanan Seafood Wholesale Market.[1]

Virus spread rapidly through China infecting more than 85,000 people. Within a few months, it engulfed the Europe causing massive loss of life and property in Italy, Spain, France, Germany, the UK, and then the USA. It is now spreading in Bangladesh which is one of the populous country of the world in relation with total land areas.[2] As of now, more than 600,900 people have been infected and 8950 people have succumbed to the illness in our country till March 2021 in Bangladesh.[3]

The WHO declared COVID-19 a global pandemic on March 11, 2020. Illness ranges in severity from asymptomatic or mild to severe; a significant proportion of patients with clinically evident infection develop severe disease. Human-to-human transmission through droplets as well as through contact with fomites acts as routes of the virus spread. Among the infected populations 80% are either asymptomatic or have mild disease, people have been going to their workplaces and even traveling internationally. Nevertheless, even though the virus is causing mild disease in many, the course of illness may be severe, leading to hospitalization and even death in elderly or those with comorbid conditions.[4]

Guan et al.[4] published a report on 1099 patients with laboratory confirmed COVID-19 from 552 hospitals in China through January 29, 2020. The most common symptoms reported were fever (43.8% on admission, and 88.7% during hospitalization) and cough (67.8%), diarrhea (3.8%) were uncommon. A severe form of the disease was reported in elderly and in patients with comorbidities. Mortality rate among diagnosed cases (case fatality rate) has a variable range; true overall mortality rate is uncertain, as the total number of cases (including undiagnosed persons with milder illness) is unknown.

Data of COVID are underway from the different parts of world but it is still scarce from Bangladesh. Hence, objectives of this paper are to describe the clinical profiles of COVID patients ranging from their age, sex, clinical symptoms, laboratory evaluation, radiological characteristics, and treatment provided along with outcome.


  Methods Top


In this observational study, we included 209 cases of reverse transcription-polymerase chain reaction (RT-PCR) positive COVID-19 patients as confirmed cases and those with RT-PCR negative but with supportive clinical history and radiological evidences as probable cases. Data were collected between June and December, 2020 from three COVID dedicated hospitals Chittagong Bangladesh. A structured questionnaire was used to collect the data and all patients were observed till discharged irrespective of outcome. Eventually 209 cases were enrolled. Informed written consent was obtained from every patient or from legal guardian by reading out according the revised declaration of helsinki. The protocol was approved by the Ethical and Scientific Committee of the Chattogram Maa O Shishu Hospital Medical College. We collected demographic data (age, sex, etc.,), clinical data (symptoms on admission, investigations reports, etc.,) and correlated them with outcome. The statistical analysis was carried out using the Statistical Package for Social Sciences version 20.0 for Windows (IBM SPSS Armonk, NY, USA). Qualitative variables such as fever, cough were expressed as frequency and percentage. Quantitative variables were expressed as mean ± standard deviation.


  Results Top


[Table 1] shows most of the patients were male 139 (66.5%) and male to female ratio was 1.98:1.
Table 1: Gender distribution

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[Table 2] shows age group distribution where patients aggregated in age group <20 years was 2 (1.0%), 21–30 years were 9 (4.3%), 31–40 years were 24 (11.5%), 41–50 years 36 (17.2%), 51–60 years were 54 (25.8%) 61–70 years 57 (27.3%), and >71 years 27 (12.9%).
Table 2: Age group distributions

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[Table 3] shows 92 (44%) patients were RT-PCR positive and 117 (56%) were probable.
Table 3: Type of covid (n=209)

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[Table 4]a shows clinical different features where fever was present in 195 (93.3%) cases, cough in 180 (86.1%), respiratory distress in 105 (50.2%) anosmia in 123 (58.8%), aguesea in 112 (53.58%), and lethargy was present in 143 (68.42%) and [Table 4]b shows patients also presented with constellation of multiple symptoms with different severity.


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[Table 5] shows Chest X-ray findings where 43 (20.6%) had normal findings, 73 (34.9%) had bilateral patchy opacities, 20 (9.6%) had unilateral opacities 65 (31.1%) had consolidations, 6 (2.9%) had ground-glass opacities and 2 (1.0%) had pleural effusion.
Table 5: CXR findings

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[Table 6] shows different treatment provided where supplemental O2 was given in 173 (82.8%) patients, Favipiravir was given in 59 (28.2%), Remdesivir was given in 111 (53.1%), methylprednisolone in 87 (41.6%), dexamethasone in 93 (44.5%), Antibiotics was given in 204 (97.60%), Toccilizumab in 34 (16.3%), plasma in 18 (8.6%), and LMWH in 200 (95.7%) patients.
Table 6: Treatment provided

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[Table 7] shows different clinical and laboratory results
Table 7: Clinical and Lab data

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[Table 8] shows outcome of COVID patients admitted where 85 (92.4%) patients improved, 6 (6.5%) died who were RT-PCR positive and 107 (91.15%) improved, 9 (7.7%) died who were probable cases. Total death rate was 7.1%.
Table 8: Relation of outcome with covid type

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  Discussion Top


First COVID-19 cases were declared by Bangladesh in Dhaka City on March 8, 2020, highest number of cases have been detected in Dhaka3 and thus it is considered as the core of the disease transmission in Bangladesh. Since then COVID cases increased gradually.[5]

Among 209 patients studied most of the patients were male 139 (66.5%) and male to female ratio was 1.98:1. It was similar to that reported by Huang et al.[6] and Chen et al.[1] which show 73.0% male predominance but higher than that reported by Wang et al.[7] (54.3%). This male predominance may have happened due to increased foreign travel by males for occupational or educational purposes.

Age group distribution revealed more were aggregated in the age group of 41–50 years 36 (17.2%), 51–60 years were 54 (25.8%) and 61–70 years 57 (27.3%). Our socio-demographic findings, matched that of Asia, for example, China[8] (median age: 47 years; 41.9% female), India[9] (mean age 40.3 years, 66.7% male) and other reports from Bangladesh[10] (43% were in the age range of 21–40 years, female: male ratio 1:2.33). However, studies from America8 (median age, 63 years) and Europe9 (Median age, 67.5 years) showed higher age of patients but the same male preponderance.

Among all 92 (44%) patients were RT-PCR positive and 117 (56%) were probable. As per case, definition RT-PCR-positive cases were taken as confirmed cases and who had clinical and radiological findings compatible with COVID-19 were taken as probable cases. RT-PCR was the first line of diagnosis in patients with COVID-19 in Bangladesh. In previous reports, chest computed tomography (CT) scan was found to be a more sensitive diagnostic tool than RT-PCR even in asymptomatic patients reaching 98%.[11] However, many researchers found that patients with a positive RT-PCR may have a negative chest CT scan, and patients with a negative RT-PCR may have positive chest CT scan.[11] Chest X-ray was regarded an insensitive tool reaching 69%.[11]

Clinical findings revealed fever was present in 195 (93.3%) cases, cough in 180 (86.1%), respiratory distress in 105 (50.2%) anosmia in 123 (58.8%), aguesea in 112 (53.58%), and lethargy was present in 143 (68.42%). In our study, fever and cough were the most common symptom present in our patients which was similar to that reported in Huang et al.[6] and Wang et al.[7] where fever and cough also were two common symptoms found. Some patients were found asymptomatic also.

The some most common chest X-ray finding in our patients were bilateral and unilateral patchy opacities and ground-glass opacities in a peripheral distribution, there was a lower lobe predilection of the opacities, with the right lower lobe more common than the left lower lobe. Our findings are in consensus with previous studies on chest X-ray and chest CT scans.[11],[12] Only two patients had pleural effusion which is not a common finding on chest imaging[13] in our study the presence of symptoms correlated significantly with abnormal chest X-ray findings suggesting that chest X-ray may be helpful as an aiding tool in the diagnosis and follow-up in patients with COVID-19 pneumonia.

Laboratory parameters were variable among confirmed cases and probable cases. C-reactive protein (CRP), Ferritin and d-dimer were used to check as inflammatory markers and hematological parameters were also reviewed. Furthermore, blood hypercoagulability is common among hospitalized COVID-19 patients. Elevated D-dimer levels were consistently reported as well. Thus, the study concluded that in patients with COVID-19 either hospitalized they are at high risk for venous thromboembolism, and an early and prolonged pharmacological thromboprophylaxis with LMWH is highly recommended.[14]

Supplemental O2 was given in 173 (82.8%) patients, Favipiravir in 59 (28.2%), Remdisivir in 111 (53.1%), Methylprednisolone in 87 (41.6%), Dexamethasone in 93 (44.5%), Antibiotics in 204 (97.60%), toccilizumab in 34 (16.3%), plasma in 18 (8.6%), and LMWH in 200 (95.7%) patients. These were different treatment options provided the patients as per the then guideline of COVID-19 patients management in Bangladesh. Currently, no anti-viral agents have been proven to be an effective treatment for COVID-19. Remdesivir in hospitalized patients on oxygen was found to have reduced hospital stay but not mortality benefit and hence around 23% cases in this series received the drug. The study showed treatment of the patients with thromboprophylaxis, oxygen therapy (as needed), judicious use of steroid and antibiotics along with symptomatic management according to treatment guidelines was suffice.[15]

Regarding outcome of the COVID patients admitted, 85 (92.4%) patients improved, 6 (6.5%) died who were RT-PCR positive and 107 (91.15%) improved, 9 (7.7%) died who were probable cases. The death rate was little higher in our study then a study done before in Bangladesh which was 4.7%.[2] Around two-third of patients could be discharged in <10 days' time, only few patients required longer duration of hospital stay (>30 days).


  Conclusion Top


According to this study, COVID-19 patients in Bangladesh have presenting symptoms such as fever, cough, and berating complaints, nausea, vomiting, lethargy, and a higher temperature of >100°F. Males were more affected then female and middle age group are also more affected. Hematological findings like CRP were found to increase among all of our study patients. Besides, an increase in serum ferritin, and D-Dimer along with erythrocytopenia and lymphocytopenia can be important supportive diagnostic criteria. Death rate is higher in our country and different treatments are applied as per national guideline which is changing with time.

Financial support and sponsorship

The study was supported by CMOSHMC.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.  Back to cited text no. 1
    
2.
Mohiuddin Chowdhury AT, Karim MR, Mehedi HH, Shahbaz M, Chowdhury MW, Dan G, et al. Analysis of the primary presenting symptoms and hematological findings of COVID-19 patients in Bangladesh. J Infect Dev Ctries 2021;15:214-23.  Back to cited text no. 2
    
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WHO, Bangladesh. Situation Report Coronavirus (COVID-19). March 31, 2021. Available from: https://www.who.int/bangladesh/emergencies/coronavirus-disease-(covid-19)-update/coronavirus-disease-(covid-2019)-bangladesh-situationreports. [Last accessed on 2021 Apr 20].  Back to cited text no. 3
    
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Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;395:497-506. [doi: 10.1056/NEJMoa2002032].  Back to cited text no. 4
    
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Mowla SG, Azad KA, Kabir A, Biswas S, Islam MT, Banik GC, et al. Clinical Profile of 100 Confirmed COVID-19 Patients Admitted in Dhaka Medical College Hospital, Dhaka, Bangladesh. J Bangladesh Coll Phys Surg 2020;38:29-36.  Back to cited text no. 5
    
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Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 6
    
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Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9.  Back to cited text no. 7
    
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Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in Hina. N Engl J Med 2020;382:1708-20.  Back to cited text no. 8
    
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Gupta N, Agrawal S, Ish P, Mishra S, Gaind R, Usha G, et al. Clinical and epidemiologic profile of the initial COVID-19 patients at a tertiary care centre in India. Monaldi Arch Chest Dis 2020;90:193-6.  Back to cited text no. 9
    
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Hossain I, Khan MH, Rahman MS, Mullick AR, Aktaruzzaman MM. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in Bangladesh: A descriptive study. JMSCR 2020;08:544-51.  Back to cited text no. 10
    
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Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: Comparison to RT-PCR. Radiology 2020;296:E115-7.  Back to cited text no. 11
    
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Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology 2020;295:202-7.  Back to cited text no. 12
    
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Wong HY, Lam HY, Fong AH. Frequency and distribution of chest radiographic findings in COVID-19 positive patients. Radiology 2019;27:201160.  Back to cited text no. 13
    
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Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, et al. Hematological findings and complications of COVID-19. Am J Hematol 2020;95:834-47.  Back to cited text no. 14
    
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Islam QT, Hossain HT, Fahim FR, Rashid MU. Clinico-demograhic profile, treatment outline and clinical outcome of 236 confirmed hospitalized Covid- 19 patients: A multi-centered descriptive study in Dhaka, Bangladesh. BJM 2020;319:52-7.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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