الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
This present study included 519 patients in a COVID-19 isolation hospital, during the first and second waves of COVID-19. Almost half of the patients (50.67%) were above 55 years of age and 39.88% were 35-55 years old. Only 20 patients (0.39%) were below 18 years of age. Males contributed 53.95 % of the studied patients. The majority of patients (n=319, 61.46%) were located in wards, 14.64% (n=76) were in the intermediate care while 23.89% (n=124) % were in the ICU. Regarding the distribution of co-morbidities and smoking history among the studied patients, 55.88% of them were hypertensive, 38.54% were asthmatics, 34.87% were diabetics and 26.01% were smokers. Hospital stays ranged between 5- 40 days (median = 20 days). A total of 106 patients (20.42%) were deceased by the end of the study.
Results of the study were as follows:
1- The most common symptom among all patients was fever (79.38%), followed by cough (78.81%), dyspnea (54.9%), and diarrhea (49.9%). The least common symptom among all patients was the loss of taste and smell (20.23%). 2- The lymphocytic counts ranged between 200-7200 cells/mm3 (median= 920cells/mm3). Lymphopenia was prevalent in 55.30% of patients, while only 7.32 % had lymphocytosis. The median CRP value was 67 IU/ml. Concerning the CO-RAD scale, 42.77% of the patients were in the CO-RAD 5 scale category.
3- The range of Ct of ORF-1 and N genes was 0-35 while the S gene had a range of 0-34 cycles. All three genes had a median range of ―25 ―. Concerning the Ct value of RTPCR, 40.08% of patients had low Ct value indicating high viral loads, 42.77% had a moderate Ct value indicating moderate viral loads while only 17.15 % had low viral loads.
4- Age was significantly positively correlated with CRP (r=0.213, p<0.001) and length of hospital stay (r=0.147, p<0.001). Age was inversely correlated with lymphocytic count (r=-0.130, p<0.003) and Ct value of the three viral genes as follows: S gene (r= -0.161, p<0.001), ORF gene (r= -0.212, p<0.001) and N gene (r= -0.194, p<0.001).
5- There was a strong positive statistically significant correlation between high viral loads of the ORF-1 and N genes; (r = 0.752, p< 0.001) and a moderate positive statistically significant correlation between the N gene and S genes (r =0.687, p <0.001) and between the ORF gene and S genes; (r = 0.698, p <0.001).
6- Lymphocytic count was significantly correlated (p<0.001) with Ct values for the 3 genes (inversely correlated with viral load). There was a moderate positive statistically significant correlation also between the length of hospitalization and the N gene (r = 0.688, p < 0.001). There was a moderate negative statistically significant correlation between the length of stay (days) and the lymphocytic count; ( r =-0.505, p < 0.001)
Summary, Conclusions, and Recommendations
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7- High CRP level (median [IQR]: 120.5 [19.25-190.00], p<0.001), low lymphocytic count (1500[920-] p<0.001), high CO-RAD [4-5]) p<0.001, older age (59[50-67] p<0.001), diabetes (p<0.001), hypertension (p<0.001), ICU admission (p<0.001), smoking (p=0.007) were all associated with high viral loads. The only symptom found to be associated with high viral load was ―loss of taste and smell‖ (p=0.005).
8- Older age, high CO-RAD scales, being a female were significantly associated with viral load and/or risk of mortality. Despite that lymphopenia, elevated CRP, diabetes and hypertension were all significant risk factors for high viral load (p<0.001), however, none of them raised the hazard risk for mortality.
9- Prolonged hospitalization and mortality were significantly associated with older age (p<0.001), diabetes (p<0.001), hypertension (p<0.001), cough (p=0.005), high CRP (p<0.001), high CO-RAD scale (p<0.001), malaise (p=0.017), dyspnea (p=0.007) and high viral load (p<0.001). The cumulative mortality probabilities were as follows: 36.1% (75/208) among patients with high, 12.6% (28/222) for those with moderate, and 3.4% (3/89) among those with low viral loads. In the ICU- admitted patients, the median survival was 19 days. For patients with high viral load, mortality rates stabilized at ―day 25 post-admission‖ after which risks of mortality did not change until day 40, while patients with low and moderate viral loads reached the peak and stabilized at day ‖20 post-admission‖. A cumulative mortality rate was 3.7% for patients in wards and 58.9% among ICU patients.
6.2. Conclusions
1- High CRP level, low lymphocytic count, high CO-RAD scale, older age, diabetes, hypertension, ICU admission and smoking were all associated with high viral load of SARS-COV-2 (low Ct value).
2- Factors associated with prolonged hospitalization among COVID-19 patients were high viral load, high CRP level, high CO-RAD scale, diabetes, hypertension, older age, being a female, cough, malaise, dyspnea and ICU admission while there was a moderate negative statistically significant correlation between prolonged hospitalization and the lymphocytic count.
3- Factors associated with mortality among COVID-19 patients were high viral load, older age, high CO-RAD scale, ICU admission, lymphocytosis, diabetes, hypertension, cough, malaise, dyspnea, smoking and being a female. Although females were not at a greater risk for having high viral loads, they had a 1.53 folds increase in adjusted hazards of death compared to males.