Comorbidities and clinical features related to Invasive Ventilatory Support among COVID-19 cases in Selangor, Malaysia
Creators: name: Hasani, Wan Shakira Rodzlan
name: Ganapathy, Shubash Shander
name: Lin, Chong Zhuo
name: Rifin, Halizah Mat
name: Bahar, Mohammad Nazaruddin
name: Ghazali, Muhammad Haikal
name: Lodz, Noor Aliza
name: Ramli, Muhammad Hafizuddin Taufik
name: Majid, Nur Liana Ab
name: Yn, Jane Ling Miaw
name: Yusof, Muhammad Fadhli Mohd
name: Ahmad, Noor Ani
name: Suleiman, Anita
name: Yusof, Ahmad Faudzi
name: Venugopalan Balan
name: Sha'ari Ngadiman
Publisher: name: Zenodo
Year: 2020
Subjects: Comorbidities
Clinical Features
Invasive Ventilatory Support
COVID-19
Selangor
Malaysia

description: <strong>Introduction </strong>Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). On March 11, 2020, the World Health Organization declared COVID-19 a pandemic1. Malaysia has also not been spared from the pandemic with a total of 4,987 infected people and 82 deaths up to April 14, 2020 2. A number of studies have shown that underlying comorbidities are predictors of severe disease outcome and greatly affect the prognosis of the COVID-19 patients3-4. COVID-19 causes severe acute respiratory syndrome and is often associated with intensive care unit (ICU) admission and subsequent mortality. Identifying the risk factors that predicts severity and outcome of COVID-19 patients early in the presentation would be extremely helpful for clinicians in managing the patients. <strong>Objective </strong>This study determined comorbidity and additional predictive factors for invasive ventilatory support (intubated) among Malaysian COVID-19 patients. <strong>Methodology </strong>This is a retrospective study using data collected during COVID-19 outbreak in Selangor, Malaysia. COVID-19 confirmed cases in Selangor that were notified up to 13th April 2020 were included into this study. A positive case of COVID-19 is confirmed based on positive Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) testing. The outcome variable was ICU admission that required intubation with mechanical ventilatory support. Predictor variables included socio demographic characteristics, comorbidities and main symptoms of COVID-19. This information were based on the case investigation reports obtained from district health offices in-charge of each patient. All the admitted COVID-19 cases were then followed up and verified via hospital medical report for information on ICU admission requiring intubation. Multiple logistic regression analysis was performed to identify the factors associated with intubation among COVID-19 cases. <strong>Results and Discussion </strong>A total of 1,287 COVID-19 positive cases were included in the analysis. Consistent with other studies, the most common presenting symptoms in this study were fever followed by cough, dyspnoea and lethargy. The most common comorbidities among COVID-19 patients were hypertension (15.5%) and diabetes (11.0%) and it was consistent with the finding on the clinical features of COVID-19 in Wuhan. Among intubated cases, 68.0% had hypertension, 88.0% had fever, 40.0% had dyspnoea and 44.0% was lethargic. Multivariable regression demonstrated that the odds of being intubated among older COVID-19 patients (≥ 60 years) was 3.9 times (aOR: 3.90, 95% CI: 1.41, 10.80) higher than those aged below 60 years. Similar to the reports from China &amp; Italy, the risk for poor prognosis is higher in older age groups. Those who had underlying hypertension had 5.7 times more odds of being intubated compared to those with no underlying hypertension (aOR: 5.71, 95% CI: 1.99, 16.45). Systematic review and meta-analysis done by Jing Yang et al. (2020) showed that the pool odds of hypertension in severe patients compared to non-severe patients was 2.36 (95% CI: 1.46-3.83). The presenting symptoms related to COVID-19 infection also play an important role in predicting poor prognosis. Presenting symptoms such as fever (aOR: 9.8, 95% CI: 2.48, 38.95), dyspnoea (aOR:9.61, 95% CI: 3.31, 27.96) and lethargy (aOR:7.92, 95% CI: 2.84, 22.09) had significantly higher risk for intubation. <strong>Conclusion </strong>COVID-19 patients aged 60 years old and older, who had hypertension, or who presented with fever, dyspnoea, or lethargy, were more likely to be intubated and ventilated. These patients need to be screened for COVID-19 when presented to any healthcare facility and monitored closely by clinicians upon diagnosis and admission. In addition, public health interventions should aim to provide additional protection to older population or people with comorbidity such as hypertension found to be more vulnerable to severe disease progression if infected with COVID-19.