Characteristics of COVID-19 Patients Admitted to a Tertiary Care Hospital in Pune, India and Predictors of Requirement for Intensive Care Treatment

Objectives: 1. To study associations of severity of COVID-19 disease with clinical features and laboratory markers. 2. To develop a model to predict the need for ICU treatment.

Methods: This is an analysis of clinical course in 800 consecutive patients from a dedicated COVID-19 tertiary care hospital in Pune, India (8th April to 15th June 2020). We obtained clinical and laboratory information, severity grading and progress from hospital records. We studied associations of these characteristics with need for ICU management. We developed a predictive model of need for ICU treatment among first 500 patients and tested its sensitivity and specificity in the following 300 patients.

Results: Average age was 41 years, 16% were 20 years of age, 55% were male, 50% were asymptomatic and 16% had at least one comorbidity. Using MoHFW India severity guidelines, 73% patients had mild, 6% moderate and 20% severe disease. Severity was associated with higher age, symptomatic presentation, elevated neutrophil and reduced lymphocyte counts and elevated inflammatory markers. Seventy-seven patients needed ICU treatment: they were older (56 years), more symptomatic and had lower SpO2 and abnormal chest X-ray and deranged hematology and biochemistry at admission. A model trained on the first 500 patients, using above variables predicted need for ICU treatment with sensitivity 80%, specificity 88% in subsequent 300 patients; exclusion of expensive laboratory tests (Ferritin, C- Reactive Protein) did not affect accuracy.

Conclusion: In the early phase of COVID- 19 pendemic, a significant proportion of hospitalized patients were young and asymptomatic. Need for ICU treatment was predicted by simple measures including higher age, symptomatic onset, low SpO2 and abnormal chest X-ray. We propose a simple model for referring patients for treatment at specialized COVID-19 hospitals.