Aim: To describe the clinical characteristics and outcomes of severe COVID-19 adult patients, with the exploration of risk factors for mortality in the hospital. Methods: This study included 20 adult patients diagnosed with COVID-19 in the ICU of DHQ Hospital Faisalabad (Pakistan) and were categorized into the survival group and death group according to the outcome. We retrieved demographics, clinical manifestations and signs, laboratory indicators, treatment measures, and clinical outcomes from the medical record, and summarized the clinical characteristics and outcomes of these patients. Results: The average age of patients was 70 ± 12 years, of which 40% were male. They were admitted to the ICU 11 days after the onset of symptoms. The most common symptoms on admission were cough (19 cases, 95%), fatigue or myalgia (18 cases, 90%), fever (17 cases, 85%), and dyspnea (16 cases, 80%). Eleven (55%) patients had underlying diseases, of which hypertension was the most common (11 cases, 55%), followed by cardiovascular disease (4 cases, 20%), and diabetes (3 cases, 15%). Six patients (30%) received invasive mechanical ventilation and continuous renal replacement therapy and eventually died. Acute heart injury was the most common complication (19 cases, 95%). Ten (50%) patients died between 2 and 19 days after admission to the ICU. Compared to dead patients, the average body weight of surviving patients was lower (61.70± 2.36 vs 68.60±7.15, P = 0.01), Glasgow Coma Scale score was higher (14.69±0.70 vs 12.70±2.45, P = 0.03), with fewer concurrent shocks (2 vs 10, P = 0.001) and acute respiratory distress syndrome (2 vs 10, P = 0.001). Conclusion: The mortality rate is high in patients with critical COVID-19 disease. Lower Glasgow Coma Scale, higher body weight, and decreased lymphocyte count appear to be potential risk factors for the death of COVID-19 patients in the ICU.

Aim: To determine the efficacy of neutrophil/lymphocyte ratio (NLR) as a marker of the severity of COVID-19 pneumonia in the South-Asian population. Methods: This was a prospective, cross-sectional, analytic study conducted at HDU/ICU of District Headquarter Hospital, Faisalabad, Pakistan, from May through July 2020. Sixty-three eligible patients, admitted to the HDU/ICU, were prospectively enrolled in the study. Their NLR, C-reactive protein, serum albumin, and serum fibrinogen were measured. Patients’ demographic characteristics, comorbidities, clinical manifestations of COVID-19 infection, medication use, and history of lung malignancy were retrieved from their medical history. Patients were categorized into either a general group (with mild COVID-19) or a heavy group (with moderate to severe COVID-19). Results: There were significant differences between the two groups in diabetes prevalence, NLR, C-reactive protein, and serum albumin. NLR and C-reactive protein were positively correlated (P < 0.001, P = 0.04 respectively) whereas serum albumin was negatively correlated (P = 0.009) with severe COVID-19. NLR was found to be an independent risk factor for severe COVID-19 pneumonia in the heavy group (OR = 1.264, 95% CI: 1.046~1.526, P = 0.015). The calculated AUC using ROC for NLR was 0.831, with an optimal limit of 4.795, sensitivity of 0.83 and specificity of 0.75, which is highly suggestive of NLR being a marker for early detection of deteriorating severe COVID-19 infection. Conclusion: NLR can be used as an early warning signal for deteriorating severe COVID-19 infection and can provide an objective basis for early identification and management of severe COVID-19 pneumonia.