Evaluation of COVID-19 Treatment Outcomes in a Military Hospital and its Comparison with a Nonmilitary Hospital

Document Type : Original Research

Authors

Biostatistics Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

Abstract

Background and Aim: Following the COVID-19 pandemic and the exposure of Iran's military and government services and hospital system to this disease, in this study we intend to the evaluation of COVID-19 treatment outcomes in a military hospital and its comparison with a nonmilitary hospital.
Methods: This cross-sectional study was performed on a sample of 535 patients (155 cases in a nonmilitary hospital and 380 cases in a military hospital) with COVID-19 patients admitted to the military and the nonmilitary hospital in Tehran city in 2021 who were selected using random sampling. Death, hospitalization in the Intensive Care Unit (ICU) and Average Length of Stay in Hospital (ALSH) were considered as treatment outcomes in this study. The standard checklist was used to collect data and SPSS software version 24 was used to analyze the data.
Results: In this study, the death rate, hospitalization in ICU and ALSH in the nonmilitary hospital were 20.6%, 40.6% and 5.15±8.23 days, respectively. These three outcomes (death rate, hospitalization in ICU and ALSH) in the military hospital were 8.9%, 15.3% and 4.30±7.56 days, respectively. The results of this study showed that the death rate (P<0.001) and ICU hospitalization (P<0.001) were statistically different between the two hospitals, but the two hospitals were similar in terms of ALSH (P=0.125).
Conclusion: Due to the difference in the type of treatment used (more corticosteroids and fewer antiviruses) in the military hospital than the nonmilitary hospital, it is possible to ensure better treatment performance in the military hospital rather than the nonmilitary hospital.

Keywords


1. WHO. WHO characterizes COVID-19 as a pandemic 2020 [Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen. 2. WHO. Coronavirus disease (COVID-19) pandemic 2020 [Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019?gclid=CjwKCAiA8Jf-BRB-EiwAWDtEGnT5aEuG4ks8f8z7dtHGUcjaM39WLnJ7x3mIhCI7qpdwCot2ITMuOxoCrgkQAvD_BwE. 3. Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. New England Journal of Medicine. 2020. 4. Al-Tawfiq JA, Al-Homoud AH, Memish ZA. Remdesivir as a possible therapeutic option for the COVID-19. Travel Med Infect Dis. 2020;101615. 5. Elfiky AA. Anti-HCV, nucleotide inhibitors, repurposing against COVID-19. Life Sciences. 2020;248:117477. 6. Mitjà O, Clotet B. Use of antiviral drugs to reduce COVID-19 transmission. Lancet Glob Health. 2020:S2214-109X(20)30114-5. 7. Cortegiani A, Ingoglia G, Ippolito M, Giarratano A, Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. Journal of Critical Care. 2020. 8. Sahu P, Galhotra A, Raj U, Ranjan RV. A study of self-reported health problems of the people living near railway tracks in Raipur city. Journal of family medicine and primary care. 2020;9(2):740-4. 9. Yang Z, Liu J, Zhou Y, Zhao X, Zhao Q, Liu J. The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis. Journal of Infection. 2020. 10. Zha L, Li S, Pan L, Tefsen B, Li Y, French N, et al. Corticosteroid treatment of patients with coronavirus disease 2019 (COVID-19). Medical Journal of Australia. 2020;n/a(n/a). 11. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. The Lancet. 2020;395(10223):473-5. 12. Vahedi E, Ghanei M, Ghazvini A, Azadi H, Izadi M, Panahi Y, et al. The clinical value of two combination regimens in the Management of Patients Suffering from Covid-19 pneumonia: a single centered, retrospective, observational study. DARU Journal of Pharmaceutical Sciences. 2020;28(2):507-16. 13. Alimohamadi Y, Sepandi M, Taghdir M, Hosamirudsari H. Determine the most common clinical symptoms in COVID-19 patients: a systematic review and meta-analysis. Journal of preventive medicine and hygiene. 2020;61(3):E304-e12. 14. Collantes MEV, Espiritu AI, Sy MCC, Anlacan VMM, Jamora RDG. Neurological Manifestations in COVID-19 Infection: A Systematic Review and Meta-Analysis. The Canadian journal of neurological sciences Le journal canadien des sciences neurologiques. 2021;48(1):66-76. 15. He X, Cheng X, Feng X, Wan H, Chen S, Xiong M. Clinical Symptom Differences Between Mild and Severe COVID-19 Patients in China: A Meta-Analysis. Frontiers in public health. 2020;8:561264. 16. Mair M, Singhavi H, Pai A, Singhavi J, Gandhi P, Conboy P, et al. A Meta-Analysis of 67 Studies with Presenting Symptoms and Laboratory Tests of COVID-19 Patients. The Laryngoscope. 2021;131(6):1254-65. 17. Ssentongo P, Ssentongo AE, Heilbrunn ES, Ba DM, Chinchilli VM. Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis. PloS one. 2020;15(8). 18. Nikpouraghdam M, Jalali Farahani A, Alishiri G, Heydari S, Ebrahimnia M, Samadinia H, et al. Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study. J Clin Virol. 2020;127(104378):21. 19. Lu L, Zhong W, Bian Z, Li Z, Zhang K, Liang B, et al. A comparison of mortality-related risk factors of COVID-19, SARS, and MERS: A systematic review and meta-analysis. The Journal of infection. 2020;81(4):e18-e25. 20. Borges do Nascimento IJ, von Groote TC, O’Mathúna DP, Abdulazeem HM, Henderson C, Jayarajah U, et al. Clinical, laboratory and radiological characteristics and outcomes of novel coronavirus (SARS-CoV-2) infection in humans: A systematic review and series of meta-analyses. PloS one. 2020;15(9):e0239235. 21. Keeley P, Buchanan D, Carolan C, Pivodic L, Tavabie S, Noble S. Symptom burden and clinical profile of COVID-19 deaths: a rapid systematic review and evidence summary. BMJ Support Palliat Care. 2020;10(4):381-4. 22. Henry BM, Cheruiyot I, Vikse J, Mutua V, Kipkorir V, Benoit J, et al. Lymphopenia and neutrophilia at admission predicts severity and mortality in patients with COVID-19: a meta-analysis. Acta Bio Medica: Atenei Parmensis. 2020;91(3):e2020008. 23. Simadibrata DM, Lubis AM. D-dimer levels on admission and all-cause mortality risk in COVID-19 patients: a meta-analysis. Epidemiology & Infection. 2020;148. 24. Rastad H, Karim H, Ejtahed HS, Tajbakhsh R, Noorisepehr M, Babaei M, et al. Risk and predictors of in-hospital mortality from COVID-19 in patients with diabetes and cardiovascular disease. Diabetol Metab Syndr. 2020;12(57):020-00565. 25. Javanian M, Bayani M, Shokri M, Sadeghi-Haddad-Zavareh M, Babazadeh A, Yeganeh B, et al. Clinical and laboratory findings from patients with COVID-19 pneumonia in Babol North of Iran: a retrospective cohort study. Rom J Intern Med. 2020;58(3):161-7. 26. Homayounieh F, Zhang EW, Babaei R, Karimi Mobin H, Sharifian M, Mohseni I, et al. Clinical and imaging features predict mortality in COVID-19 infection in Iran. PloS one. 2020;15(9). 27. Zali A, Gholamzadeh S, Mohammadi G, Azizmohammad Looha M, Akrami F, Zarean E, et al. Baseline Characteristics and Associated Factors of Mortality in COVID-19 Patients; an Analysis of 16000 Cases in Tehran, Iran. Arch Acad Emerg Med. 2020;8(1). 28. Allameh SF, Nemati S, Ghalehtaki R, Mohammadnejad E, Aghili SM, Khajavirad N, et al. Clinical Characteristics and Outcomes of 905 COVID-19 Patients Admitted to Imam Khomeini Hospital Complex in the Capital City of Tehran, Iran. Arch Iran Med. 2020;23(11):766-75. 29. Shahriarirad R, Khodamoradi Z, Erfani A, Hosseinpour H, Ranjbar K, Emami Y, et al. Epidemiological and clinical features of 2019 novel coronavirus diseases (COVID-19) in the South of Iran. BMC Infect Dis. 2020;20(1):020-05128. 30. Ghanei M, Saadat SH, Najimi-Varzaneh A, fesharaki MG. In-Hospital Death due to COVID-19 Disease in Iranian Patients: A Systematic Review and Meta-Analysis Study. Systematic Reviews. 2021;in review. 31. Ding ZY, Li GX, Chen L, Shu C, Song J, Wang W, et al. Association of liver abnormalities with in-hospital mortality in patients with COVID-19. Journal of hepatology. 2020. 32. Yan X, Li F, Wang X, Yan J, Zhu F, Tang S, et al. Neutrophil to lymphocyte ratio as prognostic and predictive factor in patients with coronavirus disease 2019: A retrospective cross-sectional study. J Med Virol. 2020;92(11):2573-81. 33. Asch DA, Sheils NE, Islam MN, Chen Y, Werner RM, Buresh J, et al. Variation in US Hospital Mortality Rates for Patients Admitted With COVID-19 During the First 6 Months of the Pandemic. JAMA internal medicine. 2020. 34. Goodman KE, Magder LS, Baghdadi JD, Pineles L, Levine AR, Perencevich EN, et al. Impact of Sex and Metabolic Comorbidities on COVID-19 Mortality Risk Across Age Groups: 66,646 Inpatients Across 613 U.S. Hospitals. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2020. 35. Izurieta HS, Graham DJ, Jiao Y, Hu M, Lu Y, Wu Y, et al. Natural history of COVID-19: Risk factors for hospitalizations and deaths among >26 million U.S. Medicare beneficiaries. The Journal of infectious diseases. 2020. 36. Mallow PJ, Belk KW, Topmiller M, Hooker EA. Outcomes of Hospitalized COVID-19 Patients by Risk Factors: Results from a United States Hospital Claims Database. J Health Econ Outcomes Res. 2020;7(2):165-74. 37. Macedo MCF, Pinheiro IM, Carvalho CJL, Fraga H, Araujo IPC, Montes SS, et al. Correlation between hospitalized patients' demographics, symptoms, comorbidities, and COVID-19 pandemic in Bahia, Brazil. PloS one. 2020;15(12):e0243966. 38. Rodilla E, Lopez-Carmona MD, Cortes X, Cobos-Palacios L, Canales S, Saez MC, et al. Impact of arterial stiffness on all-cause mortality in patients hospitalized with COVID-19 in Spain. Hypertension. 2020. 39. Piroth L, Cottenet J, Mariet AS, Bonniaud P, Blot M, Tubert-Bitter P, et al. Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: a nationwide, population-based retrospective cohort study. The Lancet Respiratory medicine. 2020. 40. Zeitoun JD, Faron M, Lefèvre JH. Impact of the local care environment and social characteristics on aggregated hospital fatality rate from COVID-19 in France: a nationwide observational study. Public Health. 2020;189:104-9. 41. Ferroni E, Giorgi Rossi P, Spila Alegiani S, Trifirò G, Pitter G, Leoni O, et al. Survival of Hospitalized COVID-19 Patients in Northern Italy: A Population-Based Cohort Study by the ITA-COVID-19 Network. Clin Epidemiol. 2020;12:1337-46. 42. Blackbourne LH, Baer DG, Eastridge BJ, Renz EM, Chung KK, Dubose J, et al. Military medical revolution: deployed hospital and en route care. The journal of trauma and acute care surgery. 2012;73(6 Suppl 5):S378-87. 43. Amir Hosein G, Ali G, Mostafa G, Ensieh V, Shideh O, Abolfazl M, et al. Evaluation of the Effect of Combination Therapy on Treatment of COVID-19: A Cohort Study. Iranian Red Crescent Medical Journal. 2021;23(6). 44. van Paassen J, Vos JS, Hoekstra EM, Neumann KMI, Boot PC, Arbous SM. Corticosteroid use in COVID-19 patients: a systematic review and meta-analysis on clinical outcomes. Critical care (London, England). 2020;24(1):696. 45. Yang Z, Liu J, Zhou Y, Zhao X, Zhao Q, Liu J. The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis. The Journal of infection. 2020;81(1):e13-e20. 46. Chang R, Elhusseiny KM, Yeh YC, Sun WZ. COVID-19 ICU and mechanical ventilation patient characteristics and outcomes-A systematic review and meta-analysis. PloS one. 2021;16(2):e0246318.