Title Page Title: A Comparative COVID 19 Characterizations and Clinical Course Analysis between ICU and Non ICU Settings

Objective: With COVID-19 pandemic severely affecting India and Ahmedabad city being one accounting for half COVID cases, objective was to determine disease course and severity of in patients at a COVID care hospital. Design: A Clinical trial registry of India registered observational study (CTRI/2020/05/025247). Setting: Certified COVID hospital located in Ahmedabad, Gujarat, India. Participants: 549 COVID positive patients hospitalized between 15 th May to 10 th August, 2020 and treated in ICU and non ICU settings. Main Outcome Measure: Comparative analysis of demographic, clinical characteristics, investigations, treatment, complications and outcome of COVID patients in ICU and non ICU settings. Results: Of the 549 hospitalized COVID positive patients, 159 were admitted in ICU during disease course while 390 had ward admissions. Overall median age was 52 (1-86) years. The ICU group was older (>65years), with associated comorbidities like hypertension and diabetes (p<0.001); higher proportion of males (79.25%); with dyspnea as a major clinical characteristic . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted October 11, 2020. ; https://doi.org/10.1101/2020.10. 07.20208389 doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. and consolidation in lungs as a major radiological finding as compared to ward patients. C reactive protein, D-Dimer and Ferritin were higher in ICU patients. Overall 50% females depicted elevated Ferritin levels. Steriods(92.45%)and tocilizumab (69.18%) were more frequently used for ICU patients . Remdesivir was prescribed to both ICU and non ICU patients. Favirapir was also a line of treatment for 25% of ICU patients. Convalescent plasma therapy was given to 7 ICU patients. Complications like acute kidney injury (13.84%), shock (10.69 %), sepsis and encephalopathy were observed in ICU patients. Overall mortality rate was 5.47 % with higher mortality among males in comparison to females (p<0.0001). Conclusion: About 29% of overall patients required ICU admission that was commonly elderly males. Chances of ICU admission were higher with baselines comorbidities (1.5 times) and dyspnea (3.4 times) respectively. A multi-specialty COVID care team and updated treatment protocols improves outcomes. Introduction The global COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has severely affected India. As reported on 6 th October 20202, with 6,685082 corona virus cases and 103600 reported deaths, India has the largest number of confirmed cases in Asia [1] and has the second highest number of confirmed cases in the world after the United States. [1] Gujarat is one of Indian states severely affected by the corona virus, with 123638 cases reported so far [2] of which Ahmedabad the economic city of Gujarat reports more than 37,000covid cases. ]3] The government of Gujarat partially locked the city of Ahmedabad on 21 st March [4] and implemented various policies to curb the pandemic. [5] Despite the pressing need for evidence to inform such key decisions, data remain limited on COVID-19 in India. Patient characteristics, illness course, practice patterns, resource utilization, morbidity, and mortality associated with COVID-19 have been characterized in only limited samples which is scattered. Characteristics of Gujarat state patients are beginning to be enumerated with limited data on hospitalized patients, including the critically ill; therefore, we sought to characterize the disease course of adult COVID-19 patients admitted at Care Institute of Medical Sciences (CIMS hospital) , Ahmedabad, Gujarat , India. We provide a detailed description of demographic data, comorbidities, presenting symptoms, clinical course, hospital complications, patient outcomes, . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted October 11, 2020. ; https://doi.org/10.1101/2020.10. 07.20208389 doi: medRxiv preprint