Analysis of COVID-19 Mortality in Allied Hospitals of Rawalpindi Medical University Pakistan

Abstract

Background and Objective: COVID-19 has emerged as a serious threat to the public health. It has been declared as Public Health Emergency of International Concern (PHEIC) because of morbidity and mortality associated with it all over the world. The objective of the present study was to analyze COVID-19 related fatalities in terms of comorbidity, length of hospital stays and critical illness in Allied hospitals of Rawalpindi Medical University. Methods: A retrospective hospital data-based research was carried out on n = 25 fatalities registered in three Allied hospitals (The data included age, gender, date of admission and death, severity of illness, comorbidity, oxygen administration or ventilator support and was gathered through consecutive sampling. The data was analyzed by using SPSS version 25.0. Fisher's Exact test was applied to determine statistical significance of association between comorbidity and need for ventilation. Statistical significance of association between length of hospital stay and comorbidity was verified by independent sample t-test. Results: Of the total n = 25 COVID-19 related fatalities in Allied hospitals, 76% were males. The mean age of study subjects was 55.9 ± 15.28 years. The greatest number of overall deaths was among 51-70 years old patients. About 44% fatalities had comorbid states with hypertension and diabetes constituting the highest (45.4%) proportion. Comorbidity had statistically significant association (P < 0.02) with need of ventilators in critically ill patients while length of hospital stays depicted insignificant association with comorbidity (P > 0.80). Conclusion: People above the age of 50 years are more likely to die due to COVID-19. Comorbid states of hypertension and diabetes should be carefully managed to avoid grave consequences.

Full text

Biomedica – Vol. 36, COVID19-S2. 2020 246
D:\Biomedica – Vol. 36, Special Issue, 2020\60-Bio-30.Doc Fig. 1-3 Color P. 246 – 250
ORIGINAL ARTICLE
Analysis of COVID-19 Mortality in Allied Hospitals of
Rawalpindi Medical University Pakistan
Shazia Zeb1, Rizwana Shahid2, Muhammad Umar3, Qaiser Aziz4, Muhammad Omar Akram5
Muhammad Khurram6, Muhammad Mujeeb Khan7
ABSTRACT
Background and Objective: COVID-19 has emerged as a serious threat to the public health. It has been
declared as Public Health Emergency of International Concern (PHEIC) because of morbidity and mortality
associated with it all over the world. The objective of the present study was to analyze COVID-19 related
fatalities in terms of comorbidity, length of hospital stays and critical illness in Allied hospitals of
Rawalpindi Medical University.
Methods: A retrospective hospital data-based research was carried out on n = 25 fatalities registered in
three Allied hospitals (Rawalpindi Institute of Urology & Transplantation, Benazir Bhutto Hospital and Holy
Family Hospital) of Rawalpindi Medical University. The data included age, gender, date of admission and
death, severity of illness, comorbidity, oxygen administration or ventilator support and was gathered
through consecutive sampling. The data was analyzed by using SPSS version 25.0. Fisher’s Exact test was
applied to determine statistical significance of association between comorbidity and need for ventilation.
Statistical significance of association between length of hospital stay and comorbidity was verified by
independent sample t-test.
Results: Of the total n = 25 COVID-19 related fatalities in Allied hospitals, 76% were males. The mean age
of study subjects was 55.9 ± 15.28 years. The greatest number of overall deaths was among 51 – 70 years
old patients. About 44% fatalities had comorbid states with hypertension and diabetes constituting the
highest (45.4%) proportion. Comorbidity had statistically significant association (P < 0.02) with need of
ventilators in critically ill patients while length of hospital stays depicted insignificant association with
comorbidity (P > 0.80).
Conclusion: People above the age of 50 years are more likely to die due to COVID-19. Comorbid states of
hypertension and diabetes should be carefully managed to avoid grave consequences.
KEYWORDS: COVID-19, Comorbidity, Critical illness, Ventilator, Hospital stay, Hypertension, Diabetes.
How to cite this:
Zeb S, Shahid R, Umar M, Aziz Q, Akram MO, Khurram M, et al. Analysis of COVID-19 mortality in Allied
hospitals of Rawalpindi Medical University Pakistan. Biomedica. 2020; 36(COVID19- S2): 246-50.
Shazia Zeb, Deputy Director
Department of Medical Education
Rawalpindi Medical University, Rawalpindi-Pakistan.
Rizwana Shahid, Assistant Professor
Department of Community Medicine
Rawalpindi Medical University, Rawalpindi-Pakistan.
Muhammad Umar, Vice Chancellor
Rawalpindi Medical University, Rawalpindi-Pakistan.
Qaiser Aziz, Senior Registrar
Department of Medicine, Rawalpindi Medical University, Rawalpindi
Muhammad Omar Akram, Postgraduate Resident
Department of Medicine
Rawalpindi Medical University
Rawalpindi-Pakistan.
Muhammad Khurram, Prof & Head
Department of Medicine
Rawalpindi Medical University
Rawalpindi-Pakistan.
Muhammad Mujeeb Khan, Associate Professor
Department of Infectious Diseases
Rawalpindi Medical University, Rawalpindi-Pakistan.

Analysis of COVID-19 Mortality in Allied Hospitals of Rawalpindi Medical University Pakistan
247 Biomedica – Vol. 36, COVID19-S2. 2020
INTRODUCTION
COVID-19 has emerged as a serious threat to the
public health. Coronavirus infection is declared as
Public Health Emergency of International Concern
(PHEIC) due to exponential growth of
consequential morbidity and mortality all over the
world.1 Victims of this infection usually experience
mild to moderate respiratory illness which in
extreme cases especially among immune-deficient
and aged population coupled with comorbidity may
escort to severe respiratory distress and poor
health outcome.2 Hence practicing respiratory
etiquettes is of paramount significance for safety
from this irresistible sickness.3
Local transmission of Coronavirus has
eventually expanded to all the six World Health
Organization (WHO) regions of the world.4 Apart
from health impact, change in lifestyle and
economic recession are also attributed to this
deadly havoc.5 Early identification of symptoms
and prompt supportive or intensive care can lessen
the progression of COVID-19 to critical illness.6
Strategic planners and public health specialists
should ensure impediment between onset of
symptoms and grave outcome by implementation
of appropriate precautionary measures and
information dissemination in the good will of
public.7
Emergence of COVID-19 as a public health
challenge globally is primarily attributed to its
contagiousness.8 Although maximum COVID-19
cases were reported in America followed by Italy
and Spain but Asian countries including Pakistan
has also reported cases that are escalating in
number with worsening of current scenario.9,10
Despite the limited governmental assets to tackle
with this emergency, quarantine services and
isolation ward in hospitals with proper Standard
Operating Procedures (SOPs) are made available in
each province of Pakistan.11,12 Death rate in
Pakistan due to Coronavirus infection is mounting
day by day.13 This issue is quite alarming and
concerned health authorities should take
indispensable steps for prompt management of the
situation.
The present study was mainly intended to
determine the key attributes of COVID-19
associated mortality reported in Allied Hospitals of
Rawalpindi Medical University. Therefore, data
pertinent to COVID-19 mortality was retrieved
through proper channel from 3 Allied Hospitals of
Rawalpindi Medical University namely Rawalpindi
Institute of Urology & Transplantation (RIUT), Holy
Family Hospital (HFH) and Benazir Bhutto Hospital
(BBH). The analysis of COVID-19 deaths would be
of great importance in ruling the risk factors
contributing to death apart from other associated
health managerial dynamics.
METHODS
A retrospective hospital data-based research was
done on n = 25 fatalities reported in RIUT, BBH and
HFH teaching hospitals of Rawalpindi Medical
University Pakistan after getting the approval from
Institutional Ethical Committee. The data included
demographics, length of hospital stay, comorbidity
and ventilator support to the fatalities and was
gathered by consecutive sampling.
STATISTICAL ANALYSIS
Data was analyzed by using Statistical Package for
Social Sciences (SPSS version 25.0). Frequency and
percentage was calculated for gender. Mean ± SD
was calculated for continuous variables like age
and length of hospital stay. Mean duration of
hospital stay among fatalities with and without
comorbidity was compared by independent sample
t-test. Statistical significance of association
between comorbidity and ventilator support
among critically ill was determined by Fisher’s
exact test.
RESULTS
Of the total n = 25 COVID-19 deaths enrolled in this
study, 76% were males and 24% were females.
Mean age of died people was 55.9 ± 15.28 years.
Mostly, (60%) of the study subjects were admitted
in Benazir Bhutto Hospital (BBH), followed by
(28%) in Rawalpindi Institute of Urology &
Transplantation (RIU&T) and a few (12%) in Holy
Family Hospital (HFH) (Fig:1).

Zeb S, et al. (2020)
Biomedica – Vol. 36, COVID19-S2. 2020 248
Fig.1: Gender based distribution of COVID-19 deaths in
Hospitals affiliated with RMU (n = 25).
Mean duration of hospital stay from admission
till death was determined to be 5.95 ± 4.22 days.
Highest fatality from COVID-19 was reported
among males with 51 – 70 years of age and females
41 – 50 years old (Fig: 2).
Fig.2: Gender wise COVID-19 fatalities in different age
groups (n = 25).
Among n = 25 COVID-19 deaths, (44%) patients
had diverse comorbid states with hypertension and
diabetes constituting the highest frequency
(45.4%) followed by (18.2%) chronic kidney
disease (CKD), (9.1%) ischemic heart disease (IHD),
(9.1%) chronic liver disease (CLD) and (9.1%)
chronic obstructive pulmonary disease (COPD).
There were patients having one or more than one
comorbid states (Fig:3).
Comorbidity was determined to have
statistically significant association (P < 0.02) with
need for ventilators among COVID-19 fatalities who
were critically ill on admission to hospital (Table-
1).
Fig.3: Frequency of distribution of co-morbid states.
Table-1: Statistical association of comorbidity with
critical illness/ventilator obligation among
COVID-19 fatalities.
Type of Illness on Admission
Total
Fisher’s
Exact Test
Critically Ill
(on ventilators)
Trivially Ill
(on Oxygen supply)
(P < 0.02)
Yes
11
0
11
No
08
06
14
19
06
25
Length of hospitalization among COVID-19
fatalities with comorbidity (8±3.85 days) and
without any chronic condition (5±8.9days)
revealed insignificant statistical association of
comorbidity with hospitalization (P>0.80).
DISCUSSION
History reminds various pandemics with long term
devastating effects and social implications. World
population is again confronted with a tiresome
challenge amid COVID-19 pandemic that has
eventually encompassed all regions of the world.
Invisibility and fatality of novel Coronavirus
(COVID-19) has vanished many lives form the
world.14
Mean age of COVID-19 fatalities in our study is
55.9 ± 15.28 years. About (76%) and (24%) deaths
were charted among males and females
respectively. About (73.7%) deaths were registered
among 51 – 70 years old males and (33.3%) deaths
among 41 – 50 years old females amid COVID-19
pandemic in Pakistan. On reviewing COVID-19
death record of Italy, mean age of fatalities was
79.5 ± 8.1 years with males constituting 70% of the

Analysis of COVID-19 Mortality in Allied Hospitals of Rawalpindi Medical University Pakistan
249 Biomedica – Vol. 36, COVID19-S2. 2020
death burden. Contrary to present study, most
(52.3%) of the deaths were eminent among Italian
population ≥ 80 years. On scrutinizing the
demographic characteristics of Italian population, it
became evident that (23%) of people there are
above 65 years of age.15 The higher COVID-19
related fatality among 80 years older people might
be attributed to more elders there as compared to
youngsters. This aspect coupled with increased
vulnerability of elders to Coronavirus infection
might contribute to escalated death toll among old
citizens. On the other hand, 53.09% of Pakistani
population is 15 – 63 years old and only 3.5%
people constitute economically dependent
population ≥ 65 years.16 The demographics of both
countries are much supportive of age differences
pertinent to COVID-19 related deaths of two
countries. Highest fatalities among Chinese citizens
were found among 60 – 79 years old
population.17Chinese demographics revealed that
about 48% residents are 25 – 54 years old and only
11.3% of citizens are ≥ 65 years old.18 One of the
probable reasons for country wise diversity in
COVID-19 related case fatality is confinement of
RT-PCR testing for people presenting with more
severe symptoms and requiring hospitalization.15
This facet necessitates in depth research to validate
the cause of age based differences in case fatalities
of various regions.
Out of n = 25 fatalities in current study, about
(44%) had various comorbid states with
hypertension and diabetes comprising (45.4%) of
pre-existing diseases. Chronic kidney disease
amounted to 18.2% while each of IHD, CLD and
COPD constituted 9.1% of comorbidity. Similarly,
Italian population revealed 35.5% of people who
died of COVID-19 had diabetes. However, 30%,
20.3% and 9.6% of them presented with IHD,
cancer and stroke respectively.15 As diabetes seems
to have some association death in patients with
COVID-19, so this aspect should be explored deeply
to determine the plausible relationship. It has been
observed in current study that 56% deaths did not
have any pre-existing disease while only 0.8% of
Italian fatalities were free from any chronic disease.
As highest proportion of Coronavirus infected
among Italians were ≥ 80 years, this seems to be an
underlying cause for greater comorbidity among
victims.15 Similarly another research among
Chinese patients depicted old age as one of the
eminent risk factors contributing to poor prognosis
of COVID-19 victims. Mean age of died patients was
69 years (95%CI 63-75). In addition, hypertension
was the most frequent (48%) comorbidity among
non-survivors followed by diabetes (31%) and
coronary heart diseases (24%).19 Hypertension and
diabetes appear to account for poor health outcome
among COVID-19 sufferers. COVID-19 cases with
these pre-existing diseases should be prioritized
for prompt healthcare management in order to
shun poor outcome.
CONCLUSION
Older male people with comorbidity are highly
vulnerable to Coronavirus infection. Further
research on from diverse regions of the world
would facilitate in drawing the true picture of this
problem.
LIMITATIONS OF STUDY
Limitations of present study is the small sample
size. A series of future studies are recommended
with larger sample size to analyze mortality in
patients with COVID-19 and its correlation with
other comorbidities.
ACKNOWLEDGMENT
The authors are thankful to the staff and physicians
of Rawalpindi Institute of Urology &
Transplantation, Benazir Bhutto Hospital and Holy
Family Hospital, Rawalpindi for their support
during this study.
CONFLICT OF INTEREST
None to declare.
FINANCIAL DISCLOSURE
None to disclose.
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Author’s Contribution
SZ: Conception and design of study, data
interpretation.
RS: Drafting and final approval of the version to be
published.
MU: Acquisition, analysis and interpretation of
data.
QA: Acquisition of data and drafting.
MOA: Critical revision of the manuscript for
intellectual content.
MK: Data interpretation, drafting.
MMK: Final approval of manuscript.