Overview of 254 mild cases of COVID-19 in Bangladeshi cohort: a cross-sectional observation
Keywords:COVID-19, Mild cases, Symptoms, Comorbidities, Biomarkers, Bangladesh
Background: The first recognition of a cluster of COVID-19 patients in China in late 2019, has become a major concern due to its greater transmissibility and vulnerability of the patient to turn to fever, cough, breathlessness, pneumonia then eventually severe acute respiratory distress syndrome requiring intensive care unit (ICU) support. But most of the affected patients get cured following mild symptoms and very only a few of them get hospitalized. The objective of the study was to observe the demographic characteristics, clinical symptoms, comorbidities, and biomarkers (hematological, inflammatory, hepatic, renal, and metabolic) of mild cases of COVID-19 infected patients admitted to the hospital during the peak four months of the pandemic.
Methods: Age, sex, symptoms, comorbidities, and biomarkers (Hb%, WBC, lymphocyte, neutrophil, platelet count, HCT(hematocrit), NLR(neutrophil-lymphocyte ratio, d-NLR derived neutrophil-lymphocyte ratio, PLR(platelet-lymphocyte-ratio), d-Dimer, ferritin, CRP(C-reactive protein), PT(prothrombin time), INR(international normalized ratio), SGPT, S.creatinine, HbA1C of all rt-PCR positive mild cases were recorded in this retrospective observational study in a tertiary care hospital dedicated to COVID-19 at Dhaka, Bangladesh was done from 15th May to 9th September, 2020. Age, sex, symptoms, and comorbidities were compared by chi-square test and biomarkers were compared by one-way ANOVA.
Results: Out of 254 cases 44 were female and 210 were male with a ratio of 1:4.77. Average age was 39.04. Largest population belongs to the 30-39 years of age range. Among the symptoms, anorexia (18.5%), fever (17.71%), and anosmia (16.9%) were most prevalent symptoms among the mild cases. However, diabetes mellitus (DM) and hypertension (HTN) were predominant comorbidities. Mostly all the biomarkers were significant among groups (Hb%, Total WBC, neutrophil count, platelet count, HCT, NLR, d-NLR, d-Dimer, ferritin, CRP, PT, SGPT, creatinine, HbA1C except lymphocyte count, PLR, and INR. The severity of disease progression depends on the co-morbidity and hyper-responsiveness inflammatory or immunological biomarkers to predict.
Conclusions: In mild cases of COVID-19 male predominance was more and the most affected group was 30-39 years. They suffered more from anorexia and fever and DM and HTN were common comorbidities. Mostly all the biomarkers were significant. Moreover, further large-scale studies are needed to evaluate the number of mild cases and their prognostic features to develop and modify the treatment strategy and public health awareness time to time.
World Metrics. COVID-19 corona virus outbreak, 2021. Available at: https://www.worldometers. k+info/coronavirus/. Accessed on 23 March 2021.
World Health Organization. Estimating mortality from COVID-19, 2020. Available at: https://www. int/newroom/commentaries/detail/estimatin- mortality-from-covid-1. Accessed on 23 March 2021.
World Metrics. COVID-19 corona virus outbreak. World Metrics, 2021. Available at: https://www.worldometers/info/coronavirus/country/Bangladesh/. Accessed on 23 March 2021.
World Health Organization. Coronavirus disease (COVID-19; Weekly Epidemiological Update, 2020. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19-31-march-2021. Accessed on 23 March 2021.
Tambe MP, Parande MA, Tapare VS, Borle PS, Lakde RN, et al. An epidemiological study of laboratory confirmed COVID-19 cases admitted in a tertiary care hospital of Pune, Maharashtra. Indian J Public Health. 2020;64:183-7.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.
Mowla SGM, Azad KAK, Kabir A, Biswas S, Islam MR, Banik GC, et al. Clinical Profile of 100 Confirmed COVID-19 Patients Admitted in Dhaka Medical College Hospital, Dhaka. Bangladesh J Bangladesh Coll Physicians Surg. 2020;38:29-36.
World Health Organization. Coronavirus disease (COVID-2019) pandemic. Available at: https://www.who.int/emergencies/disease/novel-coronavirus, 2019. Accessed on 23 March 2021.
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33.
Fan C, Li K, Ding Y, Wang J. ACE2 expression in kidney and testis damage after 2019-nCOV infection. Med rxiv. 2020.
Mahallawi WH, Khabour OF, Zhang Q, Makhdoum HM, Suliman BA. MERS-CoV infection in humans is associated with a pro-inflammatory Th1 and Th17 cytokine profile. Cytokine. 2018;104:8-13.
Government of Peoples Republic Bangladesh. Novel Coronavirus (COVID-19 guidelines). Bangladesh, 2020. Available at: https://dghs.gov.bd/index. php/en/ home5376-novel-coronavirus-covid-19-guidelines. Accessed on 23 March 2021.
Nasir M, Perveen RA, Ahmad SN, Nazeen R, Ahmed SMP. Outcome of Instrumental Oxygen Therapy in COVID-19: Survivors Versus Non-survivors in Bangladeshi Cohort. Am J Int Med. 2021;9(1):52-7.
Nasir M, Mannan M, Chowdhury ASMS, Zahan T, Perveen RA. Prevalence, Pattern and Impact of Self Medication of Anti-infective Agents During COVID-19 Outbreak in Dhaka City. Global. J of Med Res. 2020.20(7):4618.
Nasir M, Perveen RA, Saha SK, Talha KA, Selina F, Islam MA. Systematic Review on Repurposing Use of Favipiravir Against SARS-CoV-2. Mymensingh Med J. 2020;29(3):747-54.
Perveen RA, Nasir M, Murshed M, Naznin R, Ahmed SN. Remdisivir and Fevipiravir changes. Extent of Hepato-Renal Profile in COVID-19 Patients: A Cross-Sectional Observation In Bangladesh. IJMSCT. 2021;8(1):5196-01.
Hossain MM, Mark SHK, Kabir AKM, Das P, Islam MK. An Epidemiological Study of Laboratory Confirmed COVID-19 Cases Admitted In Dhaka Medical College Hospital. J Medicine. 2020;21:69-75.
Zhou P, Xing L, Yang X, Wang ZG, Hu B, Zhang L, et al. Discovery of a novel coronavirus associated with the recent pneumonia outbreak in humans and its potential bat origin. bioRxiv. 2020.
Yu Z, Zhao Z, Wang Y, Zhou Y, Ma Y, Zuo W. Single-cell RNA expression profiling of ACE2, the receptor of SARS-CoV-2. bioRxiv. 2020:919985.
Jaillon S, Berthenet K, Garlanda C. Sexual Dimorphism in Innate Immunity. Clin Rev Allergy Immunol. 2019;56(3):308-21.
Nelson LM, Simard JF, Oluyomi A, Nava V, Rosas LG, Bondy M, et al. US Public Concerns About the COVID-19 Pandemic From Results of a Survey Given via Social Media. JAMA Intern Med. 2020;180(7):1020-2.
Al MA, Alhumaid S, Alhuqbani WN, Zaidi ARZ, Alkoraisi S, Al SMF, et al. Clinical, epidemiological, and laboratory characteristics of mild-to-moderate COVID-19 patients in Saudi Arabia: an observational cohort study. Eur J Med Res. 2020;25(1):61.
Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med. 2020;18(1):206.
Talha A, Selina F, Nasir N, Rahman R, Islam S. Systematic Review on Neurological Manifestations of COVID-19 Corona Virus. J Neuroinfect Dis. 2020;11(3):291.
Islam QT, Hossain HT, Fahim FR. Clinico-Demagraphic Profile, Treatment Outline And Clinical Outcome of 236 Confirms Hospitalized COVID-19 Patients: A Multi – Centred Descriptive Study In Dhaka, Bangladesh. BJM. 2020;31:2.
Hossain HT, Chowdhry T, Majumder MI, Ava AR, Rahman QAA, Zahhiruddin. Demographic and clinical profile of 190 COVID-19 patients in a tertiary care private hospital of Dhaka, Bangladesh: an observational study. J Med. 2020;21:82-8.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
Kusumanto YH, Dam WA, Hospers GA, Meijer C, Mulder NH. Platelets and granulocytes, in particular the neutrophils, form important compartments for circulating vascular endothelial growth factor. Angiogenesis. 2003;6(4):283-7.
Tan L, Wang Q, Zhang D, Ding J, Huang Q, Tang YQ, et al. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduct Target Ther. 2020;5(1):33.
Nasir M, Perveen RA, Murshed M, Nazneen R. Survival and Biomarkers of COVID-19 Patients Treated with Remdesivir And Favipiravir In ICU During The Peak of Pandemic: A Single Centre Study In Bangladesh. J Pharm Res Int. 2020;32(45):14-22.
Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504.
Li Q, Cao Y, Chen L, Wu D, Yu J, Wang H, et al. Hematological features of persons with COVID-19. Leukemia. 2020;34(8):2163-72.
Kernan KF, Carcillo JF. Hyperferritinaemia and inflammation. Int. Immunol. 2017;29:401-9.
Bozkurt FT, Tercan M, Patmano G, Bingol Tanrıverdi T, Demir HA, Yurekli UF. Can Ferritin Levels Predict the Severity of Illness in Patients With COVID-19? Cureus. 2021;13(1):12832.
Antinori S, Cossu MV, Ridolfo AL, Rech R, Bonazzetti C, Pagani G, et al. Compassionate remdesivir treatment of severe Covid-19 pneumonia in intensive care unit (ICU) and Non-ICU patients: Clinical outcome and differences in post-treatment hospitalisation status. Pharmacol Res. 2020;158:104899.
Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J, et al. Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China. J Clin Virol. 2020;127:104364.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.