Abstract
ImportanceDespite growing literature, there is still limited understanding of factors that can predict outcomes in coronavirus disease 2019 (COVID-19) patients who require intensive care.ObjectiveTo evaluate the characteristics of COVID-19 patients admitted to the intensive care unit (ICU) and identify their associations with outcomes.BackgroundThere are limited data on the outcomes in COVID-19 patients in Pennsylvania.DesignRetrospective studySettingIntensive care units in an academic health system in Western Pennsylvania.ParticipantsPatients with reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 admitted to ICUs as direct admission or transfers from regular floors between March 1, 2020, and April 30, 2020.Main outcome(s) and measure(s)The primary outcome was inpatient mortality. Secondary outcomes included complications during ICU stay, hospital length of stay, discharge disposition, and the need for oxygen at discharge. Categorical variables are described as frequencies and continuous variables as median with interquartile range (IQR). Regression modeling was used to identify the predictors of inpatient mortality in these patients. P-value <0.05 was considered statistically significant. Analysis was performed using Stata version 15.1 (StataCorp, College Station, Texas).ResultsThe cohort included 58 consecutive patients, with a median age of 62 years (IQR 54-73), 63.8% of which were male. On presentation, constitutional symptoms were the most common (91.4%), followed by lower respiratory tract symptoms (87.9%). Tachypnea (65.5%) and hypoxia (67.2%) were the most common abnormal vital signs at presentation. Common comorbidities were cardiovascular disease (74.1%), obesity (53.5%), and diabetes (39.7%). The median Acute Physiology and Chronic Health Evaluation (APACHE) score on admission to ICU was 11 (IQR 8.5-17.5). The major complications included acute respiratory distress syndrome (ARDS) 50.0%, shock 41.4%, and acute kidney injury 41.4%. The proportion of patients who underwent mechanical ventilation, required vasopressors, or were on renal replacement therapy were 58.6%, 41.4%, and 10.3%, respectively. Overall mortality was 32.8%. Age, Charlson-comorbidity index, tachypnea, lymphopenia at presentation, high APACHE score, shock, ARDS, mechanical ventilation, and steroid use were significantly associated with mortality. Of the patients who survived their ICU stay, 63.2% were discharged home and 44.7% had a new oxygen requirement at discharge.Conclusion and relevanceOur study reports high mortality in COVID-19 patients requiring ICU care in Western Pennsylvania. Identifying factors associated with poor prognosis could help risk-stratify these patients. Prospective studies are needed to assess whether early risk stratification and triaging result in improved outcomes.
Highlights
Since its emergence, coronavirus disease 2019 (COVID-19) has remained a global health crisis and continues to impart significant social, psychological, and logistical burdens on individuals and health care systems [12]
Charlson-comorbidity index, tachypnea, lymphopenia at presentation, high Acute Physiology and Chronic Health Evaluation (APACHE) score, shock, acute respiratory distress syndrome (ARDS), mechanical ventilation, and steroid use were significantly associated with mortality
Our study reports high mortality in COVID-19 patients requiring intensive care unit (ICU) care in Western Pennsylvania
Summary
Coronavirus disease 2019 (COVID-19) has remained a global health crisis and continues to impart significant social, psychological, and logistical burdens on individuals and health care systems [12]. The United States has reported the largest number of cases, and as of July 13, 2021, there were 33,726,363 COVID-19 cases with 605,140 deaths [3]. Up to July 13, 2021, the state of Pennsylvania reported 1,214,654 COVD-19 cases with 27,769 deaths, characteristics specific to severely ill patients have not been published [8]. In this context; the present study was conducted to describe the initial experience with regards to the clinical characteristics and outcomes for patients with COVID-19 admitted to ICUs across a large health system. There are limited data on the outcomes in COVID-19 patients in Pennsylvania
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