الفهرس 
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Abstract
This was a retrospective cross sectional observational study conducted on 122 patients with COVID-19; to evaluate the morbidity and mortality of management of COVID-19 confirmed cases at isolation department in Hurghada General Hospital.
A total of 122 patients with COVID-19 were enrolled in the study.
All patients entered the isolation department or ICU unit who were confirmed as SARS-C0V-2 infection using RT-PCR test.
All patients were subjected to: full personal history will be taken with special emphasis on (age, gender, BMI and smoking), previous comorbidities (medical history), COVID-19 symptoms and vital signs), the laboratory data (CBC, CRP, serum ferritin, liver and renal functions tests, coagulation profile and D-dimer level), radiological data (CT chest affection), along with drug and antibiotic data.
We found that; the mean age of all patients was (55 ± 16.3) years. Regarding gender of the patients, (55.7%) of patients were females; while (44.3%) were males.
Regarding Baseline clinical data; (64.8%) had respiratory symptoms, (54.1%) had general & GIT Symptoms, and (47.1%) had ENT symptoms.
Regarding Co-morbidities; (31.1%) of patients had HTN and DM, (18.9%) had IHD, (0.8%) had stroke, Alzheimer, thyroid and (3.3%) liver disease, (2.5%) bronchial asthma, (7.4%) had renal disease, (1.6%) had IPF and cancer, and (3.3%) were pregnant, and (27.9%) were smokers.
Regarding Drug management data; (95.9%) of patients received Antibiotics, (39.3%) received Antivirals (remdesiver), (75.4%) received Steroids, (29.5%) received Anti-inflammatory, (6.6%) received Biologics, (83.6%) received Anti-coagulants, and (91.8%) received Vitamin C and Zinc.
Regarding Final outcome data; the average LOS was (9.2 ± 6.2) days, with (33.6%) of patients had ICU admission, (9%) had MV, (16.4%) morbidity (4.9% neurological and psychological disorders, 3.3% post-covid dependent oxygen therapy, 8.2% renal impairment), and (7.4%) mortality, while (76.2%) had improved.
The 122 COVID-19 patients were classified according to Morbidity & Mortality into 2 independent groups:
Improvement and discharge group (93 patients) and Morbidity & Mortality group (29 patients).
Comparative study between the 2 groups revealed that;
• Highly significant increase in age in Morbidity & Mortality group; compared to Improvement group (p < 0.01).
• Non-significant difference as regards sex of the patients (p > 0.05).
• Highly significant decrease in O2 saturation, BMI, General & GIT, ENT symptoms, in Morbidity & Mortality group; compared to Improvement group (p < 0.05 respectively).
• Highly significant increase in IPF in Morbidity & Mortality group; compared to Improvement group (p = 0.011).
• Highly significant increase in urea, LDH, ferritin, D-Dimer, PTT, in Morbidity & Mortality group; compared to Improvement group (p < 0.05 respectively).
• Highly significant increase in Consolidation, Reticulations and Crazy paving sign (CT chest), in Morbidity & Mortality group; compared to Improvement group (p < 0.05).
• Highly significant increase in Antiviral administration (remdesiver), in Morbidity & Mortality group; compared to Improvement group (p < 0.05).
• Highly significant increase in LOS, ICU admission and MV, in Morbidity & Mortality group; compared to Improvement group (p < 0.05 respectively).
Correlation studies revealed that;
• Spearman’s correlation analysis showed that; HR, MAP, Ferritin, CT chest affection, COVID-19 Severity, had a highly significant positive correlation with LOS (p < 0.01 respectively).
• Spearman’s correlation analysis showed that; temperature, O2 saturation, PO2, had a highly significant negative correlation with LOS (p < 0.01 respectively).
• Logistic regression analysis showed that; the increase in age, BMI, LDH, D-dimer, CT Chest affection and COVID-19 severity; had an independent effect on increasing the probability of ICU admission occurrence; with significant statistical difference (p < 0.05 respectively).
• Logistic regression analysis showed that; the decrease in O2 saturation, urea, PTT; had an independent effect on increasing the probability of ICU admission occurrence; with significant statistical difference (p < 0.05 respectively).
• Logistic regression analysis showed that; the increase in urea and LDH; had an independent effect on increasing the probability of Mortality occurrence; with significant statistical difference (p < 0.05 respectively).
• Logistic regression analysis showed that; the decrease in O2 saturation; had an independent effect on increasing the probability of Mortality occurrence; with significant statistical difference (p = 0.016).
ROC curve analysis to predict Mortality:
• By using ROC-curve analysis, increased urea predicted patients with Mortality, with poor (69%) accuracy, sensitivity= 77% and specificity= 59% (p < 0.05).
• By using ROC-curve analysis, increased LDH predicted patients with Mortality, with good (81%) accuracy, sensitivity= 62% and specificity= 90% (p < 0.01).
• By using ROC-curve analysis, increased ferritin predicted patients with Mortality, with fair (74%) accuracy, sensitivity= 87% and specificity= 61% (p < 0.01).
• By using ROC-curve analysis, increased D-dimer predicted patients with Mortality, with good (81%) accuracy, sensitivity= 100% and specificity= 59% (p < 0.01).
• By using ROC-curve analysis, decreased PO2 predicted patients with Mortality, with fair (72%) accuracy, sensitivity= 85% and specificity= 51% (p < 0.01).
• By using ROC-curve analysis, increased CT chest affection predicted patients with Mortality, with fair (79%) accuracy, sensitivity= 88% and specificity= 61% (p < 0.01).
• By using ROC-curve analysis, decreased Anti-inflammatory administration predicted patients with Mortality, with poor (65%) accuracy, sensitivity= 100% and specificity= 31% (p < 0.05).
Conclusion: To conclude, our study of COVID-19 patients admitted to Hurghada isolation hospital proved that age, and different comorbidities e.g., DM, HTN, IHD, lung fibrosis, were strongly related to adverse outcomes e.g., ICU admission and mortality in COVID-19 patients.
Strict treatment protocols and isolations lead to better outcomes.
LIMITATIONS
• Small size sample.
• Lack of follow up in some patients.
• High heterogeneity existed in the published data about the treatment protocols.
• Strict control over patient comorbidities (DM, HTN, IHD), lead to less mortality rates.
• Anti-Inflammatory drugs were recommended for severe cases and lead to better results.
• Strict follow up of covid patient for detection the outcome of drugs.
• Follow up post-covid pulmonary & extra pulmonary disease.