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Assessment of Risk Factors for Severe Illness in Hospitalized CovId-19 Patients at a Tertiary Care Hospital.

Background: COVID-19 -19 is caused by severe acute respiratory syndrome coronavirus (SAR-COV-2). Identification of risk factors for severe illness helps in stratification of patients who may benefit from aggressive management strategies and early intervention.We aim to assess the risk factors for severe illness in patients admitted with COVID 19 infection. Methods: We conducted a retrospective observational study of 802 patients with confirmed COVID-19 admitted to our tertiary care hospital. Univariate and multivariate logistic regression were used to identify determinants for disease severity. Results: Of 802 hospitalized patients, severe COVID-19 infection was noted in (n= 537) (67%) patients. Patients with severe infection were significantly more likely to have hypertension, diabetes, and chronic pulmonary disease and had significantly higher white blood cell counts, NLR and decreased haemoglobin than patients with non severe infection. In multivariable logistic regression analysis, risk factors for severe infection included pre-existing hypertension (OR 2.29, 95% CI; (1.532-3.423), longer duration of symptoms before hospitalization (OR:1.158,95% CI(1.098-1.221),P<0.001) and Neutrophil lymphocyte ratio(NLR) >3. 8(OR, 1.101,95% CI (1.068-1.135); P<0.001). ROC curve for NLR shows that NLR at a cut off more than 3.8 has sensitivity of 80.5% and specificity of 58% in predicting severe illness. Conclusions: Patients with pre-existing hypertension, longer duration symptoms before hospitalization and high NLR (>3.8) needs early intervention to prevent the potential development of severe COVID-19.