Published: 2022-09-28

Predictors of mortality among COVID-19 patients admitted in a dedicated COVID hospital during the pandemic in Himachal Pradesh, India

Anita Thakur, Durgesh K. Thakur, Chitvan Thakur


Background: The outcome of COVID-19 disease is variable. Mostly patients have mild to moderate disease and get recovered; some patients have severe disease leading to mortality. Hence it is essential to find out the factors affecting the outcome in the COVID-19 patients. The aim of this study was to identify predictors of mortality among hospitalized patients of COVID-19 and to estimate their prevalence among these patients.

Methods: This was an observational study, longitudinal in design, carried out among 790 COVID-19 patients hospitalized in a tertiary care dedicated COVID hospital in Himachal, during the second wave of COVID.

Results: Overall 26.2% of the hospitalized patients were having one or more co morbidities. DM (17.6%) and delayed hospitalization (42.7%) were highly prevalent risk factors among hospitalized patients with high mortality 39.6% and 49% respectively. Overall mortality rate among study participants was 29.7%. Patients having malignancy and other immuno-compromising diseases had highest mortality rate 68.4%. Median time gap between onset of symptoms and hospitalization was 9 days among those who died and 5 days among those who recovered. On multivariate logistic regression analysis higher age (>60 years) AOR 5.392 (3.435-8.463), delayed hospital admission AOR 8.204 (5.522-12.188), diabetes mellitus AOR 1.888 (CI-1.199-2.972), malignancy and other immune compromising diseases AOR 9.108 (2.934-28.270) and chronic kidney disease AOR 7.524 (CI=2.289-27.735) were the significant predictors of mortality.

Conclusions: We observed the higher COVID-19 mortality among the patients having higher age, DM, CKD, immunocompromising diseases and delay in hospitalization. DM and delayed hospitalization were two most prevalent risk factors present among these patients.


COVID-19 mortality, Comorbidities, Pandemic, Predictors, Delayed hospitalization

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Andrews MA, Areekal B, Rajesh KR, Krishnan J, Suryakala R, Krishnan B, et al. First confirmed case of COVID-19 infection in India: A case report. Indian J Med Res. 2020;151:490.

Ministry of Health and Family Welfare Government of India. Available at: Accessed on 30 May 2021.

Mohan A, Tiwari P, Bhatnagar S, Patel A, Maurya A, Dar L, et al. Clinico-demographic profile & hospital outcomes of COVID-19 patients admitted at a tertiary care centre in north India. Indian J Med Res. 2020;152:61.

Clark A, Jit M, Warren-Gash C, Guthrie B, Wang HH, Mercer SW, et al. Centre for the Mathematical Modelling of Infectious Diseases COVID-19 working group. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. Lancet Glob Health. 2020;8:e1003-17.

Alaa A, Qian Z, Rashbass J, Benger J, van der Schaar M. Retrospective cohort study of admission timing and mortality following COVID-19 infection in England. BMJ Open. 2020;10:e042712.

Agarwal N, Biswas B, Lohani P. Epidemiological determinants of COVID-19 infection and mortality: A study among patients presenting with severe acute respiratory illness during the pandemic in Bihar, India. Niger Postgrad Med J. 2020;27:293.

Gandhi PA, Kathirvel S. Epidemiological studies on coronavirus disease 2019 pandemic in India: Too little and too late? Med J Armed Forces India. 2020;76:364.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395:1054-62.

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323:1574-81.

Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020;323:1775-6.

Sohrabi C, Alsafi Z, O'neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71-6.

Opal SM, Girard TD, Ely EW. The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis. 2005;41:S504-12.

Olivas-Martínez A, Cárdenas-Fragoso JL, Jiménez JV, Lozano-Cruz OA, Ortiz-Brizuela E, Tovar-Méndez VH,et al. In-hospital mortality from severe COVID-19 in a tertiary care center in Mexico City; causes of death, risk factors and the impact of hospital saturation. Plos One. 2021;16:e0245772.

Bello-Chavolla OY, Bahena-López JP, Antonio-Villa NE, Vargas-Vázquez A, González-Díaz A, Márquez-Salinas A, et al. Predicting mortality due to SARS-CoV-2: a mechanistic score relating obesity and diabetes to COVID-19 outcomes in Mexico. J Clin Endocrinol Metab. 2020;105(8):2752-61.

Akhtar H, Khalid S, Rahman FU, et al. Delayed admissions and efficacy of steroid use in patients with critical and severe COVID-19: an apprehensive approach. J Public Health (Oxf). 2021;fdab239.

Alaa A, Qian Z, Rashbass J, Benger J, van der Schaar M. Retrospective cohort study of admission timing and mortality following COVID-19 infection in England. BMJ Open. 2020;10:e042712.

Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020;180:1345-55.

Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ ; HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 202;395(10229):1033-4.

Muniyappa R, Gubbi S. COVID-19 pandemic, coronaviruses, and diabetes mellitus. Am J Physiol Endo-crinol Metab. 2020;318:E736-41.

Hodgson K, Morris J, Bridson T, Govan B, Rush C, Ketheesan N. Immunological mechanisms contributing to the double burden of diabetes and intracellular bacterial infections. Immunology. 2015;144:171-85.

Pandita A, Gillani FS, Shi Y, Hardesty A, McCarthy M, Aridi J, Farmakiotis D, Chiang SS, Beckwith CG. Predictors of severity and mortality among patients hospitalized with COVID-19 in Rhode Island. Plos One. 2021;16:e0252411.

Ahmad S, Kumar P, Shekhar S, Saha R, Ranjan A, Pandey S. Epidemiological, Clinical, and Laboratory Predictors of In-Hospital Mortality Among COVID-19 Patients Admitted in a Tertiary COVID Dedicated Hospital, Northern India: A Retrospective Observational Study. J Prim Care Community Health. 2021;12:21501327211041486.

Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97:829-38.

Ji D, Zhang D, Xu J, Chen Z, Yang T, Zhao P, Chen G, Cheng G, Wang Y, Bi J, Tan L. Prediction for progression risk in patients with COVID-19 pneumonia: the CALL score. Clin Infect Dis. 2020;71:1393-9.