Clinical characteristics of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV2) patients in Hospital Tengku Ampuan Afzan

BACKGROUND: The COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aims to describe the clinical characteristics of COVID-19 patients admitted to Hospital Tengku Ampuan Afzan (HTAA), Pahang, Malaysia and to identify the clinical and laboratory markers for severe disease, complications and virologic clearance according to clinical staging.

METHODS: This was a single-centre, retrospective, descriptive study. All COVID-19 patients admitted to HTAA from March 9 to April 15, 2020, were included in the study. Patients were categorised according to clinical staging. Data obtained from the medical report includes baseline characteristics of patients, comorbidities, presenting symptoms, laboratory findings, treatments, complications, and outcomes.

RESULTS: Of the total of 247 patients hospitalised, the majority consisted at clinical-stage 1 (43%) and stage 2 (39%) disease. Older patients, diabetes mellitus, hypertension, cardiovascular diseases, and chronic kidney disease were found more common among patients with severe disease. Fever was uncommon and the majority had normal haemoglobin levels, white cell counts, and platelet counts. C-reactive protein (CRP) was found statistically significant to predict pneumonia or hypoxia at a cut-off value of 14mg/L (sensitivity 73.8%, specificity 91.3%) and 50mg/L (sensitivity 100%, specificity 96.4%) respectively. Pneumonia was mostly diagnosed radiologically using chest radiography, especially among clinical stage 3. Acute kidney injury (AKI) was a significant complication, with 31% of clinical stage 3 and above developed AKI and 44% of them requiring haemodialysis. Median virologic clearance time was 15 days from onset of illness, and asymptomatic patients had longer clearance time.

CONCLUSION: COVID-19 presented with a wide spectrum of clinical patterns. CRP was a valuable predictor of severe disease. In this study risk and severity of acute kidney injury were found to be higher. A longer duration of virologic clearance was observed among the asymptomatic patients.