Predisposing factors associated with the severity of the illness in adults with Covid-19 in Nepal.

Jha, R. K.; Shrestha, A.; Tamang, B.; K.C., I.; Sah, S. K.

Objective: We aimed to determine the prevalence of the severity of COVID-19 illness and its associated predisposing factors in Nepal. Design: Cross-sectional, observational study Setting: Single-centered hospital-based study, conducted at Nepal armed police force (APF) hospital, Kathmandu, Nepal. Participants: All individuals aged greater than or equal to 18 years with laboratory-confirmed SARS-Cov-2 (the SARS-CoV-2 specific real-time- RT- PCR result positive), regardless the severity of their disease. Measurements: Disease severity was evaluated as a primary outcome and age, sex, BMI, smoking history, alcohol history, Hypertension, diabetes mellitus were evaluated as predictors in the analysis. Results: Mean ages of the patients were 40.79 plus or minus 16.04 years, and about two-thirds of the patients were male 146 (73.7%). More than half 57.1% (95%CI: 52.42-61.51) of the population had a mild infection, whereas 16.7% (95%CI: 7.4-24.6%) had severe/critical illness. In univariate analysis, each 1- year increase in age (OR: 1.05; 95% CI:1.030-1.081; P<0.001), each 1 unit increase in BMI (OR:1.12; 95% CI:1.02-1.25; P=0.033), comorbid illness (OR: 5.79; 95%CI: 2.51-13.33; P<0.001), hypertension (OR:5.95; 95%CI:2.66-13.30: P<0.001), diabetes mellitus (OR:3.26; 95%CI:1.30-8.15: P<0.005), and fever (OR:34.64; 95% CI:7.98-150.38; P<0.001) were independently associated with severity of the disease, whereas age (OR: 1.049; 95% CI: 1.019-1.080; P=0.02), hypertension (OR: 4.77; 95%CI: 1.62-14.04; P=0.004), and fever (OR: 51.02; 95%CI: 9.56-272.51; P<0.001) remained a significant predictive factors in multivariate analysis. Conclusion: The majority of the patients with COVID-19 had a mild illness, with 16.7% severe illness. Age, BMI, hypertension, diabetes mellitus, comorbidity, and temperature were associated the severity of the illness. Age, hypertension, and fever emerged as an independent predictive factor in multivariate analysis, and thus, these vulnerable groups should be given special protection to the infection and proactive intervention should be initiated at an early stage of the infection to diminish the severity of the illness and improve the clinical outcome of the disease. Keywords: COVID-19, disease severity, risk factors, SARS-CoV-19