The ICMR study indicates elevated death rates among individuals with post-Covid complications up to a year after hospital discharge.
6.5 percent of patients admitted to the hospital with moderate to severe Covid-19 infection died at the conclusion of the one-year follow-up period. (iStock)
A study carried out by a network of hospitals under the Indian Council of Medical Research (ICMR) found that individuals experiencing post-Covid conditions after hospital discharge were nearly three times more likely to die during the following year, compared to those who remained asymptomatic.
As per the ICMR study, 6.5 percent of patients admitted to the hospital with moderate to severe Covid-19 infection died at the conclusion of the one-year follow-up period.
“We observed that the male gender, age above 40 years of age, with history of moderate-to-severe Covid-19 disease, and presence of comorbidities increased the odds of death within one year of discharge from the hospital,” noted the study.
Post-Covid complications were reported by 17.1 percent of the participants at the 4-8-week follow-up.
Of the 14,419 participants who were followed up with at least once between four weeks and one year post-discharge, 942 (6.5 per cent) had died and the remaining (93.5 per cent) were reported alive.
The study, titled ‘Determinants of post-discharge mortality among hospitalised Covid-19 patients: Nested matched case-control analyses from the National Clinical Registry for Covid-19’, has been published in the Indian Journal of Medical Research (IJMR).
It was conducted by the National Clinical Registry for Covid-19 study team.
The country’s apex research body, the Indian Council of Medical Research (ICMR), has been maintaining the National Clinical Registry for Covid-19 at 31 centres across the country, where all hospitalised Covid-19 patients are periodically contacted by telephone till one year after discharge.
Data collected till February 2023 were included in this analysis.
Emphasis was put on the 18-45 age group to understand the factors associated with post-discharge death in young adults. Factors associated with death in this group after discharge were similar to the ones observed in other age brackets.
“The primary point I’d like to emphasise is that this study does not focus solely on Covid-19 mortality. Instead, it examines a specific subgroup of individuals who survived their Covid hospitalisation, tracking their outcomes over the course of a year to determine how many remained alive by the end of that period,” Dr Rajeev Jayadevan, physician and Co-Chairman of the National Indian Medical Association Covid Task Force, told South First.
He added that it is essential to note that the study includes deaths caused by various conditions, although the causes of death aren’t specified in the paper. The primary aim is to document the number of individuals who passed away in this subgroup, which is 6.5 percent.
However, the study does uncover specific risk factors associated with higher mortality rates. These factors include advancing age, particularly in men above 40, and the presence of certain pre-existing medical conditions.
Additionally, individuals who were unvaccinated prior to contracting Covid-19 were found to be at a greater risk of not surviving the year, he said.
A one-year follow-up of Covid-19 patients discharged from hospitals found that participants who received at least one dose of the Covid vaccination before contracting the Coronavirus infection had a lower risk of post-discharge mortality, stated the ICMR study.
Vaccination prior to the Covid-19 infection (at least a single dose) provided 60 percent protection against post-discharge mortality.
People older than 40 years, men with co-morbidities, and those who had moderate to severe Covid-19 to begin with had a higher chance of all-cause mortality within one year of discharge from hospital, stated the study.
Prior anti-Covid-19 vaccination did lend some protection against all-cause post-discharge death in this age group, although this cannot be claimed conclusively as the association was not statistically significant.
Dr Jayadevan said that vaccines influence the course of Covid-19 primarily because vaccinated individuals who contract the virus tend to experience a milder form of the disease. The study, in fact, goes on to show that even after initial recovery from Covid, there is a clear difference in death rates over the subsequent one-year period.
To make it clear with an example, Dr Jayadevan said that if we hypothetically consider two groups with Covid — one vaccinated and the other unvaccinated — facing identical circumstances, the study shows that the vaccinated group is likely to fare better over the course of the year.
“In other words, there doesn’t seem to be as many deaths among vaccinated Covid-recovered individuals, compared to Covid-recovered people who are unvaccinated,” said Dr Jayadevan.
Dr Jayadevan said that comparing Covid-related mortality rate with that of other diseases affecting the same population is a complex task.
“This study involves a diverse group of individuals, not confined to a specific demographic group or type of ailment like heart disease or asthma. The observed mortality rate will depend on the baseline health conditions of the participants. For instance, in certain parts of the country, individuals who reach the hospital are often critically ill and may succumb within a day.
“Conversely, in more privileged settings, healthier individuals admitted to the hospital simply as a precaution have a lower likelihood of dying. Due to this diversity, making direct comparisons can be challenging. However they looked at multiple centres, which helps iron out such baseline differences,” said Dr Jayadevan.
He further said that we can broadly say that the observed mortality rate in India aligns with rates in other parts of the world.
“Our rate of 6.5 percent is not drastically different from a 7.5 percent rate observed elsewhere,” he stated.
“This suggests that, overall, our mortality rate is comparable to global trends,” he concluded.
The limitations of the current investigation include reliance on telephonic follow-up, which could have led to under-reporting of the symptoms.
The present analyses only included patients who were hospitalised due to Covid-19 and, consequently, the findings cannot be generalised to all patients who had Covid-19, the study stated.
ICMR is also conducting a multi-centric, hospital-based matched case-control study on the effect of Covid-19 vaccines on thrombotic events among the 18-45-year-old population in India in 2022 and on factors associated with sudden death among adults aged 18-45 years in India.
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