Predictors of mortality and the need of mechanical ventilation in confirmed COVID-19 patients presenting to the emergency department in North India

Soorya Suresh; Atul Tiwari; Roshan Mathew; Jyothiswaroop Bhaskararayuni; Ankit Kumar Sahu; Praveen Aggarwal; L R Murmu; Sanjeev Bhoi; Jamshed Nayer; Meera Ekka; Akshay Kumar; Prakash Mishra; Tej Prakash Sinha

doi:10.4103/jfmpc.jfmpc_1775_20

Predictors of mortality and the need of mechanical ventilation in confirmed COVID-19 patients presenting to the emergency department in North India

J Family Med Prim Care. 2021 Jan;10(1):542-549. doi: 10.4103/jfmpc.jfmpc_1775_20. Epub 2021 Jan 30.

Affiliation

¹ Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Background and objectives: As the number of COVID-19 cases keeps on rising, a better awareness of the nature and severity of the disease will aid in clinical decision-making and management. Hence, this study was conducted to find the predictors of mortality and the need for mechanical ventilation in COVID-19 patients.

Methods: This was a single centre, prospective observational study conducted in a tertiary care centre in north India. We included patients with influenza like illness who tested positive for COVID-19. Information regarding patient demography, symptoms, and vital signs on presentation, laboratory values, chest imaging findings, and disease severity was collected by the emergency physician. QSOFA score and National early warning score (NEWS) score were calculated using initial vital signs. Each patient was followed up till discharge or death.

Results: We included 116 COVID-19 patients with 33 patients having mild, 46 patients with severe and 37 patients with critical disease. The median age of our patients was 47 years (39-59) with 63% males. About 58% of patients had at least one comorbidity and shortness of breath was the most common presenting feature. The patients with severe and critical disease had a significantly higher respiratory rate and heart rate as compared to mild disease (p < 0.05). SpO2 of those with critical disease was significantly lower as compared to those with mild disease. Mechanical ventilation was required in around 36% of patients which included 67% of patients with critical disease. The overall mortality was 51% with 90% among critical disease. Lower SpO2 and GCS were the only parameters that showed a significant association with mortality and need for mechanical ventilation. The receiver operating characteristics analysis showed NEWS score as a better predictor of mortality and need for mechanical ventilation as compared to qSOFA score.

Conclusion: NEWS and qSOFA scores are useful tools in predicting fatal outcomes in COVID patients with NEWS score being a better score than qSOFA.

Keywords: COVID-19; emergency department; mortality; predictors; profile.