A Retrospective Observational Study of Hypoxic COVID-19 Patients Treated with Immunomodulatory Drugs in a Tertiary Care Hospital

Nilesh Mahale; Prasad Rajhans; Purushotham Godavarthy; Vikram L Narasimhan; Gauri Oak; Srinath Marreddy; Amruta Bedekar; Ujwal Dhundi; Harshwardhan S Pawar; Prasad Akole; Balasaheb Pawar; Bhagyashri Bhurke; Shailaja Chavan; Parikshit Prayag; Bharat Purandare; Pradip Dalvi; Vishnu Telbhare; Prasanna Marudwar; Dnyaneshwar Diwane; Manasi Shahane; Amrita Prayag; Shradha Gugale; Shreyas Bhor; Sameer Jog

doi:10.5005/jp-journals-10071-23599

A Retrospective Observational Study of Hypoxic COVID-19 Patients Treated with Immunomodulatory Drugs in a Tertiary Care Hospital

Indian J Crit Care Med. 2020 Nov;24(11):1020-1027. doi: 10.5005/jp-journals-10071-23599.

Authors

Nilesh Mahale¹, Prasad Rajhans¹, Purushotham Godavarthy¹, Vikram L Narasimhan¹, Gauri Oak², Srinath Marreddy¹, Amruta Bedekar³, Ujwal Dhundi¹, Harshwardhan S Pawar¹, Prasad Akole¹, Balasaheb Pawar¹, Bhagyashri Bhurke¹, Shailaja Chavan⁴, Parikshit Prayag⁴, Bharat Purandare¹, Pradip Dalvi¹, Vishnu Telbhare¹, Prasanna Marudwar¹, Dnyaneshwar Diwane¹, Manasi Shahane¹, Amrita Prayag¹, Shradha Gugale¹, Shreyas Bhor¹, Sameer Jog¹

Affiliations

¹ Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India.
² Department of Research, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India.
³ Department of Anaesthesiology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India.
⁴ Department of Infectious Diseases, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India.

Abstract

Objectives: To describe the demographics and evaluate the clinical outcomes of hypoxic coronavirus disease-2019 (COVID-19) patients treated with different immunomodulatory (IM) drugs in a resource-limited setting.

Materials and methods: We conducted a retrospective cohort study of these patients admitted to our hospital between March 22 and May 31, 2020. Data were abstracted from multiple electronic data sources or patient charts to provide information on patient characteristics, clinical, laboratory variables, and outcomes.

Results: A total of 134 patients met the inclusion criteria and were followed up till June 7, 2020. The median age of the patients was 55.6 years (range 20-89 years) and 68% were men. At least one comorbidity was seen in 72% of the patients with diabetes (44%) and hypertension (46%) being the most common. At triage, fever (82%), shortness of breath (77%), and cough (61%) were the most common presenting symptoms. A PaO₂/FiO₂ ratio less than 300 was seen in 60%, and 4.5% required invasive mechanical ventilation within 72 hours of hospital admission. Five immunomodulatory agents (hydroxychloroquine, methylprednisolone, colchicine, etoricoxib, and tocilizumab) were administered in different combinations. Overall, in-hospital mortality was 26.9%, and 32% required mechanical ventilation. Around 69% of patients were discharged home. Five variables (SpO₂, PaO₂/FiO₂ ratio, leucocytosis, lymphopenia, and creatinine) on admission were found to be significant in the patients who died.

Conclusion: Our study provides the characteristics and outcomes of hypoxic COVID-19 patients treated with IM drugs in varied combination. Five independent variables were strong predictors of mortality.

How to cite this article: Mahale N, Rajhans P, Godavarthy P, Narasimhan VL, Oak G, Marreddy S, et al. A Retrospective Observational Study of Hypoxic COVID-19 Patients Treated with Immunomodulatory Drugs in a Tertiary Care Hospital. Indian J Crit Care Med 2020;24(11):1020-1027.

Keywords: Acute respiratory distress syndrome; Coronavirus disease-2019; Immunomodulatory drugs; Resource-limited settings.