ORIGINAL ARTICLE Journal of the College of Physicians and Surgeons Pakistan 2021, Vol. 31(06): 638-643 638 Predictors of Disease Severity in Adult Covid-19 Patients Admitted in Mayo Hospital, Lahore, Pakistan Tazeen Nazar, Bilal Aziz, Bilquis Shabbir, Furqan Saeed, Kashif Nawaz and Muhammad Nabeel Department of East Medical Ward, King Edward Medical University, Mayo Hospital, Lahore, Pakistan ABSTRACT Objective: To assess disease severity, based on clinical presentation and laboratory investigations. Study Design: Observational study. Place and Duration of Study: COVID-19 Isolation Unit of Mayo Hospital, Lahore from 15th March to 31st May, 2020. Methodology: Four hundred and forty-five COVID-19 RT-PCR positive patients of either gender in age group of 18-80 years, admitted in isolation wards, high dependency units (HDUs) and intensive care units (ICUs) of the Hospital, were selected for the study via simple random sampling. Clinical presentations and laboratory investigations were recorded for all patients. Kruskal-Wallis test, Pearson Chi-square test, boxplots and ROC curve were used to analyse the data. A p-value ≤0.05 was considered statistically signifi- cant. Results: Out of the 445 cases, a male predominance 286 (64.3%) was observed with majority of patients 324 (72.8%) having mild disease, 73 (16.4%) moderate, 25 (5.6%) severe and 23 (5.2%) having critical disease. D-dimer was considered to be the best discrimi- natory marker to assess disease severity with an overall accuracy of 92.1%. Conclusion: Fever, sore throat, shortness of breath, body aches, abdominal pain, anosmia and aguesia were the predominant symp- toms in majority of patients belonging to different categories based on disease severity. Inflammatory markers like D-dimers and ferritin levels determined the overall disease severity with a high accuracy. Key Words: Disease severity, Clinical presentation, Laboratory investigations, RT-PCR. How to cite this article: Nazar T, Aziz B, Shabbir B, Saeed F, Nawaz K, Nabeel M. Predictors of Disease Severity in Adult Covid-19 Patients Admitted in Mayo Hospital, Lahore, Pakistan. J Coll Physicians Surg Pak 2021; 31(06):638-643. INTRODUCTION COVID-19hastakentheworldbyastorm.Ithaswreckedhavocwith the lives of millions of people worldwide. As of 12 th April, 2021, 136 million people have been affected with 2.94 million deaths attributed to this deadly virus. 1 Thediseasehasbeenrelapsingandrecurringinwaves,owingtoits varied presentation from the involvement of respiratory tract to affecting cardiovascular, neurological, gastrointestinal, hepatic, musculoskeletal and almost every organ system of the body. 2 COVID-19affectspeopleofallagegroups.InChina,themedianage ofpatientswas30-79yearswithamalepreponderance. 3-7 Thevirus mainly affected individuals having comorbidities like diabetes, hypertension, cardiovascular and cerebrovascular disorders. 8-11 Following a heavy influx of COVID-19 patients with multiple and variedpresentations,itwasdecidedtocarryoutastudythatwould highlightthevariousabnormalitiesobservedintheclinical,labora- toryandradiologicalfindingsthatpredictthecourseofthedisease in the admitted patients. Correspondence to: Dr. Tazeen Nazar, Department of East Medical Ward, King Edward Medical University Mayo Hospital, Lahore, Pakistan E-mail: tazeennazar@gmail.com ..................................................... Received: October 05, 2020; Revised: April 15, 2021; Accepted: April 28, 2021 DOI: https://doi.org/10.29271/jcpsp.2021.06.638 TheideawastogeneratedatafromthePakistanipopulation.At the time when this study was started, only limited international data was available. The study also intended to help the health- care providers identify risk factors enabling them to devise a strategy that will minimise disease progression and formulate treatment guidelines. Theobjectiveofthisstudywastoassessdiseaseseverity,based on clinical presentation and laboratory investigations. METHODOLOGY This observational study included 445 cases of COVID-19, admittedinMayoHospital,Lahore,from15 th Marchto31stMay, 2020. Diagnosis was made based on PCR positive result and only those patients were enrolled in the study, and the date of PCRpositivitywastakenasfirstdayofillness.Thepatientswere categorised as mild, moderate, severe and critical, based on theirinitialpresentation.Thepatient’sdiseasewasclassifiedas mild, moderate, severe and critical, according to the guidelines issued by the Ministry of National Health Services, Regulations and Coordination, Government of Pakistan. 12 Mild cases were those who had symptoms of COVID-19, like cough, shortness of breath or difficulty in breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, loss of taste or smell, but without any hemodynamic compromise, need for oxygen or chest X-ray findings, oxygen