Clinical Profiles and Outcomes of Patients Pak Armed Forces Med J 2021; 71 (2): 694-701 694 CLINICAL PROFILES AND OUTCOMES OF PATIENTS ADMITTED WITH MODERATE TO CRITICAL CORONAVIRUS DISEASE 2019 (COVID-19) Sultan Mehmood Kamran, Zill-e-Humayun, Arshad Naseem, Mehmood Hussain, Yousaf Jamal, Waqar Malik*, Salman Saleem Pak Emirates Military Hospital / National University of Medical Sciences (NUMS) Rawalpindi Pakistan, *York Teaching Hospital, Clifton, York, United Kingdom ABSTRACT Objective: To evaluate various demographic, clinical, radiological and hematological manifestations of moderate to critical coronavirus disease 2019 (COVID-19) and to assess its complications and outcomes in the Pakistani population. Study Design: Retrospective observational study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Apr to Jul 2020. Methodology: Demographic, clinical, radiological and hematological data of 600 consecutive patients were retrieved and analyzed from hospital registry. Results: Overall, 449 (74.8%) patients had at least 1 comorbidity, diabetes mellitus being commonest; 228 (38%) [95% CI, 34.1- 42%]. The most common symptoms were cough; 451 (75.2%), fever; 450 (75%) and shortness of breath; 419 (69.8%). At presen- tation, 222 (37%) patients had moderate disease, 296 (49.3%) severe and 82 (12.7%) had critical disease. At admission, 277 (46.2%) patients required respiratory support and further 185 (30.8%) patients required treatment escalation later on correlated with disease severity and age (p<0.001). A total of 92 (15.3%) patients died out of which 38 (21.2%) were on noninvasive ventilation and 36 (66.6%) on invasive ventilation, (p<0.001). Overall survival (OS) was 84.7%; log rank <0.001. Mortality was highest in critical disease, 72 (31.3%) (p<0.001). A majority of patients, 440 (73.3%) developed complications, the most common being Cytokine release storm (CRS); 57.5% respiratory failure; 43.8% and Acute respiratory distress syndrome (ARDS); 38.8%. Thrombotic events occurred in 106 (17.6%). Conclusion: Majority of patients with moderate to severe COVID-19 had comorbidities and ended up in various complications. Keywords: Acute respiratory distress syndrome, Critical disease, Cytokine release storm, Mechanical ventilation, Noninvasive ventilation, SARS-CoV-2. INTRODUCTION Knowledge of the baseline characteristics and out- comes of coronavirus disease 2019 (COVID-19) is cru- cial for health and government officials engaged in pla- nning efforts to address local outbreaks. By the end of July 2020, globally >80 million confirmed cases of coronavirus disease 2019 (COVID-19) has been repor- ted of which, 486834 confirmed cases of COVID-19 are recorded in Pakistan 1 . The government of Pakistan res- ponded to this outbreak by implementing smart lock- down and designating some tertiary care hospitals as COVID-19 specific such as Pak Emirates Military Hos- pital (PEMH). Limited knowledge is available about the baseline characteristics of COVID-19 in Pakistani population compared to population of America 2 and China 3 being comprehensively studied. The features and outcome of COVID-19 might be different in Pakis- tan because there are significant differences between the Pakistani population with that of Americans and Chinese in the context of demographic characteristics and prevalence of non-communicable diseases 4 . For instance, percentage population 65 years and above in America is 16% compared to 11% in China and only 4% in Pakistan according to 2019 estimates from World bank 5 . This study evaluated various clinical, labora- tory and radiological manifestations of this deadly inf- ectious disease as well as to see its complications and outcomes in the Pakistani population. METHODOLOGY This retrospective observational study was per- formed at Pak Emirates Military Hospital (PEMH). The study was approved by Ethics Review Committee via letter no A/28/be/201/2020. In this study, a retrospec- tive analysis of records of all patients admitted with confirmed COVID-19 between April to July 2020 was performed. Non-probability convinience sampling was used. The inclusion criteria included COVID-19 diag- nosed by Real Time-Polymerase Chain Reaction (RT- PCR) positivity for SARS-CoV-2, and moderate, severe or critical illness in accordance with WHO criteria 6 . COVID-19 infection was confirmed by RT-PCR sampling results of nasopharyngeal and oropharyn- geal swabs at the time of admission. Disease severity This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Correspondence: Dr Mehmood Hussain, Department of Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan Received: 12 Dec 2020; revised received: 25 Apr 2021; accepted: 26 Apr 2021 mehmoodamcolian@gmail.com Original Article Open Access