Multi-center study to analyse outcome of integrated treatment approach in COVID-19 patients
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20230228Keywords:
COVID-19, Limited resource setting, Minimal use of oxygen, Mortality, Patient outcome, Progesterone as immunomodulator, Treatment strategyAbstract
Background: This study presents the outcome of integrated treatment approach based on government mandated standard allopathic treatment along with alternatives in COVID-19 patients. The aim of our study was to investigate the outcome of treatment strategy, co-morbid status, recovery and mortality rate of COVID-19 patients at Bhaktivedanta Hospital and Research Institute.
Methods: Post ethics committee approval for multiple centers, data for 1049 COVID-19 patients (RTPCR confirmed cases) of all age groups and genders which were admitted in a dedicated covid hospital from March 2020 to November 2020 was analysed retrospectively.
Results: This study highlights the management of COVID-19 patients with an integrated approach. In our cohort with 36.7%, 44.70 %, 18.58% of mild, moderate and severe cases respectively, mortality rate was only 3.43% of total positive patients admitted at our hospital.
Conclusions: We emphasize that even in healthcare facilities with limited resource and poor infrastructure and lack of ICU facilities, clinical observation-based management can help to reduce mortality considerably. Unique features of our study include use of progesterone as an immune modulator, use of dual antiviral agents and use of age-related lower limit of oxygen saturation.
Metrics
References
Wang C, Wang Z, Wang G, Lau JY, Zhang K, Li W. COVID-19 in early 2021: current status and looking forward. Signal Transduction and Targeted Therapy. 2021;6(1):1-4.
Icmr.gov.in. 2021. Available from: https://www.icmr.gov.in/pdf/covid/techdoc/COVID_Management_Algorithm_17052021.pdf. Accessed on17 July 2021.
Chidambaram V, Tun NL, Haque WZ, Majella MG, Sivakumar RK, Kumar A, et al. Factors associated with disease severity and mortality among patients with COVID-19: a systematic review and meta-analysis. PloS One. 2020;15(11):e0241541..
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(10223):507-13.
Soneja M, Kumar R, Bhattacharya B, Meena V, Aggarwal A, Tripathi M, et al. Characteristics and outcomes of 231 COVID-19 cases admitted at a tertiary facility in India: an observational cohort study. J Fam Med Prim Care. 2020;9(12):6267.
Baidya D, Kayina C, Haritha D, Soni L, Behera S, Nair P, et al. Epidemiological and clinical characteristics and early outcome of COVID-19 patients in a tertiary care teaching hospital in India: a preliminary analysis. Indian J Med Res. 2020;152(1):100.
Bhandari S, Singh A, Sharma R, Rankawat G, Banerjee S, Gupta V, et al. Characteristics, treatment outcomes and role of hydroxychloroquine among 522 COVID-19 hospitalized patients in Jaipur City: an epidemio-clinical study. J Assoc Phys India. 2020;68(6):13-9.
Mohan A, Tiwari P, Bhatnagar S, Patel A, Maurya A, Dar L, et al. Clinico-demographic profile and hospital outcomes of COVID-19 patients admitted at a tertiary care centre in north India. Indian J Med Res. 2020;152(1 and 2):61-9.
Bairwa M, Kumar R, Ajmal M, Bahurupi Y, Kant R. Predictors of critical illness and mortality based on symptoms and initial physical examination for patients with SARS-CoV-2: a retrospective cohort study. J Infect Public Health. 2021;14(8):1028-34.
Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5):2000547.
Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging. 2020;12(7):6049.
Singh AK, Gupta R, Misra A. Comorbidities in COVID-19: outcomes in hypertensive cohort and controversies with renin angiotensin system blockers. Diabetes Metab Syndr Clin Res Rev. 2020;14:283-7.
Zhu L, She ZG, Cheng X, Qin JJ, Zhang XJ, Cai J, et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 2020;31:1068-77.
Osibogun A, Balogun M, Abayomi A, Idris J, Kuyinu Y, Odukoya O, et al. Outcomes of COVID-19 patients with comorbidities in southwest Nigeria. PloS One. 2021;16(3):e0248281.
Malhotra V, Basu S, Sharma N, Kumar S, Garg S, Dushyant K, et al. Outcomes among 10,314 hospitalized COVID‐19 patients at a tertiary care government hospital in Delhi, India. J Med Virol. 2021;93(7):4553-8.
Bhandari S, Tak A, Singhal S, Shukla J, Shaktawat AS, Gupta J, et al. Patient flow dynamics in hospital systems during times of COVID-19: Cox proportional hazard regression analysis. Front Public Health. 2020;8:585850.
Mohandas P, Periasamy S, Marappan M, Sampath A, Sundaram VK, Cherian VK. Clinical review of COVID-19 patients presenting to a quaternary care private hospital in South India: a retrospective study. Clin Epidemiol Glob Health. 2021;11:100751.
Bhargava A, Szpunar SM, Sharma M, Fukushima EA, Hoshi S, Levine M, et al. Clinical features and risk factors for in-hospital mortality from COVID-19 infection at a tertiary care medical center, at the onset of the US COVID-19 pandemic. J Intensi Care Med. 2021;36(6):711-8.
Gray WK, Navaratnam AV, Day J, Babu P, Mackinnon S, Adelaja I, et al. Variability in COVID-19 in-hospital mortality rates between national health service trusts and regions in England: a national observational study for the getting it right first time programme. E Clin Med. 2021;35(100859):100859.
Vlachos S, Wong A, Metaxa V, Canestrini S, Lopez Soto C, Periselneris J, et al. Hospital mortality and resource implications of hospitalisation with COVID-19 in London, UK: a prospective cohort study. Crit Care Res Pract. 2021;2021:8832660.
Docherty AB, Mulholland RH, Lone NI, Cheyne CP, De Angelis D, Diaz-Ordaz K, et al. Changes in in-hospital mortality in the first wave of COVID-19: a multicentre prospective observational cohort study using the WHO clinical characterisation protocol UK. Lancet Respir Med. 2021;9(7):773-85.
Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO clinical characterisation protocol: prospective observational cohort study. BMJ. 2020;369:m1985.
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(16):1574-81.
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(2):e0245772.
Rieg S, von Cube M, Kalbhenn J, Utzolino S, Pernice K, Bechet L, et al. COVID-19 in-hospital mortality and mode of death in a dynamic and non-restricted tertiary care model in Germany. PLoS One. 2020;15(11):e0242127.
COVID-19 mortality rate rose by 40% in 2nd wave, more deaths among people under 45 years, finds study. Firstpost.com. 2021. Available from: https://www.firstpost.com/india/covid-19-mortality-rate-rose-by-40-in-2nd-wave-more-deaths-among-people-under-45-years-finds-study-9763471.html. Accessed on 19 July 2021.
Suleyman G, Fadel RA, Malette KM, Hammond C, Abdulla H, Entz A, et al. Clinical characteristics and morbidity associated with Coronavirus disease 2019 in a series of patients in metropolitan Detroit. JAMA Netw Open. 2020;3(6):e2012270.
Lindner S, Kubitschke L, Lionis C, Anastasaki M, Kirchmayer U, Giacomini S, et al. Can integrated care help in meeting the challenges posed on our health care systems by COVID-19? Some preliminary lessons learned from the European VIGOUR Project. Int J Integr Care. 2020;20(4).
Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic treatments for coronavirus disease 2019 (COVID-19). JAMA. 2020;323(18).
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China. JAMA. 2020;323(13).
Liu H, Chen S, Liu M, Nie H, Lu H. Comorbid chronic diseases are strongly correlated with disease severity among COVID-19 patients: a systematic review and meta-analysis. Aging Dis. 2020;11(3):668-78.
Sankhe AP, Memane NS, Gawali VP, Memane SN, Ramakrishnan G, Kundu T, et al. A randomized, controlled, blinded, parallel group, clinical trial to study the role of Ayurcov (AyurCoro3), one day regimen as an adjuvant therapy for COVID-19 disease management, at dedicated Covid Hospital (DCH) in India. Complement Therap Med. 2022;67:102824.