Characteristics of hospitalized COVID-19 patients in a major referral center in Shiraz, Iran
Razieh Dowran1, Fahime Edalat2, Majid Fardi2, Seyed Mohammad Ali Hashemi3, Afagh Moattari2
1 Department of Virology, School of Public Health, Tehran University of Medical Sciences; Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
3 Department of Microbiology, Golestan University of Medical Sciences, Gorgan, Iran
|Date of Submission||20-Dec-2021|
|Date of Acceptance||04-Oct-2022|
|Date of Web Publication||30-May-2023|
Prof. Afagh Moattari
Zand Street, Imam Hossein Square, Shiraz
Source of Support: None, Conflict of Interest: None
Background: Several countries, including Iran, have been affected by the novel Coronavirus Disease 2019 (COVID-19) pandemic since December 2019. The aim of this study was to provide a comprehensive report on COVID-19 patients in Shiraz, Southern Iran.
Materials and Methods: This study was performed on 311 hospitalized patients with COVID-19. The data on demographic, clinical, and paraclinical features were analyzed.
Results: The median age of the patients was 58 years, with 42.1% of the patients being above 60 years of age. Upon admission, fever was detected in 28.2% of critically ill patients. At least one underlying disease or risk factor was also present in 75.6% of the patients. Shortness of breath was the most common clinical symptom (66.2%), dry cough (53.7%), and muscle pain (40.5%) was the second and third. Sneezing (0.3%), rhinorrhea (0.7%), and sore throat (3.09%) were observed only in non-critically ill patients. In addition, 26.9% of all patients had lymphocytopenia, 25.8% had raised C-reactive protein, and 79.9% had abnormal creatinine levels. Finally, death occurred in 39 patients (12.5%).
Conclusions: Noncritically ill patients were younger than critically ill patients. The most common risk factors for getting critically ill were surgery, hypertension, diabetes mellitus, chronic heart disease, asthma, and chronic renal disease.
Keywords: Clinical characteristics, coronavirus, COVID-19, Iran, SARS-CoV-2
|How to cite this article:|
Dowran R, Edalat F, Fardi M, Hashemi SM, Moattari A. Characteristics of hospitalized COVID-19 patients in a major referral center in Shiraz, Iran. Adv Biomed Res 2023;12:137
|How to cite this URL:|
Dowran R, Edalat F, Fardi M, Hashemi SM, Moattari A. Characteristics of hospitalized COVID-19 patients in a major referral center in Shiraz, Iran. Adv Biomed Res [serial online] 2023 [cited 2023 Sep 26];12:137. Available from: https://www.advbiores.net/text.asp?2023/12/1/137/377863
| Introduction|| |
The COVID-19 pandemic has influenced more than 87 million people, causing 1.9 million deaths worldwide. On February 19, 2020, two deaths were reported in Qom, and Iranian officials announced that COVID-19 is spreading in the country. The virus was rapidly spread in Iran, and all 31 provinces were infected by March 5, 2020. A total of 1.26 million cases were confirmed by January 7, with 55,830 deaths and 1.04 million recoveries. Since the beginning of the COVID-19 pandemic, three peaks were experienced. The third peak was the most pronounced and more than 14,000 new cases were detected per day on November 27, 2020.,,,
Multiple reports have described the symptoms and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients, providing an overview of the experiences of Chinese city or regional hospitals,,, Singapore, New York City,, Italy, Spain, Germany, the United kingdom, and the United States. The initial data from China showed that 80% of patients had moderate symptoms. Additionally, approximately 20% of patients were admitted to hospitals, 25% of those required to be treated in intensive care units (ICUs).,, Overall, SARS-CoV-2 infection exerted variable impacts on different patient populations. Furthermore, even within the same country, COVID-19 hospitalizations and deaths varied across areas, which were attributed to the differences in population characteristics and access to healthcare system resources.,
This study was conducted to provide a comprehensive view of the patients' condition in terms of laboratory data and clinical characteristics.The purpose of this study was to state the baseline features and outcomes of an unselected, unbiased, and a large cohort of hospitalized COVID-19 patients who had completed their hospital stays in Ali-e-Asghar Hospital, as the main healthcare center for COVID-19 cases in Shiraz, Iran.
| Materials and Methods|| |
This observational study was conducted on the medical records of the patients with a confirmed SARS-CoV-2 infection admitted to Ali-e-Asghar Hospital affiliated to Shiraz University of Medical Sciences between March 27 and July 14, 2020. SARS-CoV-2 was confirmed using real time-polymerase chain reaction (RT-PCR) of nasopharyngeal specimens. This study was approved by the Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1399.2).
In the case of continuous variables, the mean + SD or median with interquartile range (IQR) was reported, while in the case of categorical variables, the absolute number and percentage were presented. Mann–Whitney test and Welch's t-test were used to analyze nonparametric and parametric variables, respectively. All analyses were done using the SPSS 20 software (SPSS incorporate, Chicago).
| Results|| |
The final cohort included 311 hospitalized patients [Table 1], in whom SARS-CoV-2 was detected by RT-PCR on nasopharyngeal swabs from March 27 until July 14, 2020. The median hospitalization time was 7 days (IQR: 6.00–9.00) for noncritically ill patients and 12.5 days (IQR: 10.00–19.5) for critically ill patients. Patients who were admitted to ICU were considered as critically ill. In addition, 12.5% of the patients died in the hospital, whose characteristics are shown in [Table 2] and [Table 3].
|Table 1: Comparing hospitalized patients' demographics and paraclinical results between those who are seriously ill and those who are not|
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The patients' characteristics, categorized by the illness situation, have been presented in [Table 1]. Briefly, males comprised 53.05% of the participants. Besides, the median age of the patients was 58 (37–67) years and 42.1% were above 60 years old [Figure 1]. The age distribution of critically ill and noncritically ill patients has been illustrated in [Figure 1]. Accordingly, patients with critical illnesses were older than those without critical illnesses (68 (IQR: 57–73) vs. 58 (IQR: 37–67), P = 0.002).
|Figure 1: The age distribution of the patients with respect to critically ill and noncritically ill conditions|
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At least one underlying disease or risk factor was present in 75.6% of the patients. The presence of comorbidity was upper in critically ill patients, but the difference was not a statistically significant result. The most common risk factors were surgery (31.5%), arterial hypertension (28.9%), diabetes mellitus (24.1%), chronic heart disease (19.3%), asthma (5.5%), and chronic renal disease (5.1%). Allergy was more frequent in critically ill patients (20%) than in the noncritically ill group (1.4%, P = 0.001). Only 2.2% of the patients had cancer who were critically ill and none was affected by HIV [Table 1]. In 28.6% of the critically ill patients, fever exceeded 37.8°C, which was significant compared to the noncritically ill group (p = 0.013). The most typical clinical symptom to be reported was breathlessness (66.2%), dry cough (53.7%), muscle pain (40.5%), chills (29.9%), lethargy (25.4%), headache (18.7%), and anorexia (13.2%) [Table 1]. Additionally, vomiting was evident in 10% of the patients who were not critically ill compared to 0% for not critically ill patients (p = 0.004). Furthermore, sneezing (0.3%), rhinorrhea (0.7%), and sore throat (3.09%) were observed only in noncritically ill patients.
A laboratory test conducted at the time of admission revealed the following: 26.9% of the patients had lymphocytopenia and 25.8% had elevated C-reactive protein. Moreover, the level of alkaline phosphatase was lower in the noncritically ill group in comparison with the critically ill patients (p = 0.021). The results also revealed a significant difference between the critically ill and noncritically ill patients regarding the median levels of white blood cells (WBCs) and platelets (p = 0.002 and P < 0.019, respectively). Furthermore, abnormal creatinine levels were observed in 79.9% of the patients.
| Discussion|| |
This observational study was carried out on 311 COVID-19 patients, involved 272 survivors and 39 dead cases. In line with other studies,, the findings of the current research showed that increasing age was highly linked to severe conditions in patients with COVID-19. Similarly, Zhou et al. disclosed that older age could negatively affect the prognosis (odds ratio = 1.10) in patients diagnosed with COVID-19. Older age was also found to be a significant, independent mortality indicator in Middle East respiratory syndrome (MERS) and SARS., It has been suggested that age-dependent B-cell and T-cell deficiencies, additionally to the overproduction of type 2 cytokines, might be associated with deficiencies in viral replication control and sustained inflammatory reactions, resulting in poor outcomes.
Generally, females are less vulnerable to viral diseases because of their innate immune responses, steroid hormones, and sex chromosomes. Despite the fact that one of the X chromosomes is not active, females are less susceptible to viral disease. Previous studies, revealed a threefold higher mortality rate among males compared to females. In the present study, however, no significant differences were observed between the males and females in terms of the critical condition, which is in concordance to some studies but in contrast to most.,
There was no association between current smoking status and adverse prognosis in COVID-19 patients included in a meta-analysis of 1,399 Chinese patients. Consistently, smoking habits had no effects on the patients' illness conditions in the present study.
The current study findings indicated an increase in the levels of WBCs, neutrophils, and platelets as well as a decrease in the level of lymphocytes in critically ill patients. These findings were previously reported as a significant prognostic predictor of COVID-19. Elevated platelet count, as an inflammation indicator, might highlight the inflammatory processes in critically ill patients. Nevertheless, differences in neutrophils count might show sepsis or secondary infections in this population. COVID-19 patients with decreased lymphocyte levels have also shown to have a poor prognosis, according to other studies.,
In the present study, 12.5% of the patients died, which was higher compared to some reports (1, 2)., One of the most effective and durable healthcare systems in the Eastern Mediterranean region is found in Iran's health sector, which has been faced with many obstacles,, as a result of the COVID-19 pandemic coincide with the highest unilateral sanctions imposed by the United States against Iran. Consequently, the epidemic burden as well as the number of deaths has increased.
The authors would like to thank Ms. A. Keivanshekouh at the Research Consultation Center (RCC) of Shiraz University of Medical Sciences for her invaluable assistance in editing the manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]