**1. Introduction**

Cases of pneumonia with unknown cause emerged in Wuhan, China, in December 2019 [1]. Epidemic investigation and gene sequencing revealed that a novel corona virus was the etiologic agent. The virus was tentatively named 2019-nCoV but officially named severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) later by the Coronavirus

**Citation:** Bastola, A.; Shrestha, S.; Nepal, R.; Maharjan, K.; Shrestha, B.; Chalise, B.S.; Thapa, P.; Balla, P.; Sapkota, A.; Shah, P. Clinical Mortality Review of COVID-19 Patients at Sukraraj Tropical and Infectious Disease Hospital, Nepal; A Retrospective Study. *Trop. Med. Infect. Dis.* **2021**, *6*, 137. https://doi.org/ 10.3390/tropicalmed6030137

Academic Editors: Lucille Blumberg, Peter A. Leggat and John Frean

Received: 18 June 2021 Accepted: 9 July 2021 Published: 19 July 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

Study Group of the International Committee on Taxonomy of Viruses and the disease caused by this virus was named as COVID-19 by the World Health Organization [2,3]. Globally, as of 7 July 2021, there have been 184,324,026 confirmed cases of COVID-19, including 3,992,680 deaths, reported to WHO [4].

It has been one year since Nepal reported its first COVID-19 patient. Sukraraj Tropical and Infectious Disease Hospital (STIDH), the only central governmen<sup>t</sup> infectious disease hospital of Nepal, was the first to diagnose and treat the first-ever patient infected with COVID-19 in the country [5]. As of 7 July 2021, there have been 650,162 confirmed cases of COVID-19, including 9291 deaths accounting 1.42% of cases, reported to Ministry of Health and Population, Nepal [6].

The demographics of inpatient mortalities in published studies show association with different factors, such as age >60 years, male gender and multiple co-morbidities [7,8]. However, mortality data in Nepalese context is lacking. This study describes the demographic characteristics of COVID-19 mortalities in STIDH and observation of risk factors that contributed to mortality. As a central tropical and infectious disease hospital in Nepal, experiences of mortality at STIDH during this pandemic could help describe situational awareness and guide interventional strategies and responses at community and national levels, especially for low and middle income countries like Nepal.

#### **2. Materials and Methods**

#### *2.1. Study Design and Participants*

This was a retrospective, observational study that included all inpatients from Sukraraj Tropical and Infectious Disease Hospital, who were reverse transcriptase polymerase chain reaction positive for SARS-COV-2 and died during the study period from January 2020 to January 2021.

Out of total 860 COVID-19 confirmed cases (reverse transcriptase polymerase chain reaction positive for SARS-COV-2) admitted at STIDH during the study duration, there were 50 mortalities, which were included in the study.

COVID-19 cases were categorized as asymptomatic or pre-symptomatic, mild, moderate, severe and critical and were defined as follows [9]:


The study was approved by the Ethical Review Board of Nepal Health Research Council prior to start of data collection (Reference number 169/2021P, date of approval— 21 March 2021) and permission was taken from the hospital director to include medical records of the inpatients of STIDH. Since this was a retrospective study and the data were analyzed anonymously, the requirement for taking consent was waived off by the ethical review board.

#### *2.2. Ethics and Data Collection*

Demographic, clinical, laboratory, treatment and outcome data were extracted from medical records using a data collection form. Two experienced clinicians reviewed and abstracted the data. Data were entered into a computerized database and cross-checked.

### *2.3. Statistical Analysis*

Statistical analyses were done using IBM Statistical Packages for Social Sciences (SPSS), version 20.0 (IBM Corp., IBM SPSS Statistics for Windows, Armonk, NY, USA). Continuous variables were directly expressed as median and interquartile range (IQR) values. Categorical variables were expressed as numbers and percentages (%). Pearson Chi-Square test and Fisher's exact test were used as appropriate, based on the distribution and *p*-values were tabulated with a level of significance set at <0.05.
