Clinical characteristic of first COVID-19 patients hospitalized at the multidisciplinary clinic of the Tashkent Medical Academy: A single-center retrospective study
Keywords:
clinical characteristics, COVID-19, ICU, symptomatic, Uzbekistan, risk factors INTRODUCTION: The disease, which started abruptly in China during December, after which it spread across the world, was later named coronavirus disease (COVID-19), and the virus spreading it was recognized by the WHO as SARS-CoV-2.1,2 According to Huang et al.,3 the course of the disease ranges from an asymptomatic form to admission into the intensive care unit (ICU). The disease proceeds mainly in a mild form, whereas approximately 20% of symptomatic patients require treatment in the ICU owing to complications resulting from additional severe diseases.4,5 Jane et al. described that older age, male gender, symptoms, such as high fever, fatigue, cough, and comorbidities, including cardiovascular disease, hypertension, and diabetes mellitus, were significant criteria for the occurrence of severe illness and admission to the ICU.6 Currently, one of the most urgent problems facing medicine is the early detection of emergency cases, which results in ICUs being used for the transition to death, and such cases overwhelm the healthcare system. Strengthening and expanding the capacity of primary health care can help overcome this challenge.7 Uzbekistan has currently not been overwhelmed by COVID-19. On March 15, 2020, the Ministry of Health, Republic of Uzbekistan, reported on the official social channel that the first case was detected when an Uzbek citizen returned from France. A sharp increase in such incidents has been noted since the beginning of June 2020, with the number of deaths rising from two to six per day, and the maximum number of new cases was noted in early August 2020. To date, several studies8 regarding the early COVID-19 situation in Uzbekistan have been published. However, there is an overall lack of research published in international journals regarding the epidemiological and clinical features obtained from laboratory and treatment information, which can describe the first six months of the pandemic in the Republic of Uzbekistan. Therefore, this study aimedAbstract
Background. Owing to the rapid spread of coronavirus disease (COVID-19) globally, and specifically in Uzbekistan, it has become important for the healthcare system to predict the course of the disease, its severity, and the possibility of admission into the intensive care unit (ICU). This study aimed to describe the epidemiological and clinical aspects of COVID-19 patients at the multidisciplinary clinic of the Tashkent Medical Academy, Uzbekistan, and identify the risk factors for admission into the (ICU).
Methods. Medical records of 2500 discharged and deceased COVID-19 patients at the multidisciplinary clinic of the Tashkent Medical Academy between April 11 and August 8, 2020 were accessed and analyzed. Further, the demographics, symptoms, clinical outcomes, and laboratory and treatment data were collected through medical records of patients and the risk factors for ICU admission were identified.
Results. Out of the 2500 patients, 989 were asymptomatic, and 1511 had at least one symptom. The median age of the patients was 36 [26–51], ranging from 1-91 years. A total of 978 (39.1%) patients were women, including 31 (1.2%) who were pregnant. The symptomatic group was also divided into two groups: non-ICU and ICU patients. Of all the hospitalized patients, a total of 129 patients (5.16%) were admitted to the ICU. The clinical classification of COVID-19 was different in both groups. In the ICU group, severe (45, 34.9%) and critical (48, 37.2%) severity was dominant. The ICU group suffered from high temperatures in the range of 37.4 °C–38 ºC. The respiratory rate in the range of 25–30 was experienced by 67 (51.9%) patients, and 61 (47.3%) ICU patients suffered from <79 oxygen saturation. Comorbidities, such as hypertensive heart disease (41.1%), stable angina (39.5%), hypertension (35.6%), and diabetes mellitus (21.7%), were higher among the ICU group. Logistic regression analyses showed that higher odds of ICU admission were related to older age and comorbidities, such as ischemic heart disease and diabetes mellitus.
Conclusion. It is necessary to pay attention to family clusters and cases where the route of transmission of the disease is unknown. Additionally, special consideration should be given to men, elderly patients, and comorbidities, such as heart disease, diabetes mellitus, because they present a high probability of admission into the ICU. This study is useful as a basis for an accurate and rapid assessment of the COVID-19 situation in Uzbekistan and for the development of preventive healthcare policy in this direction.
