Clinical Characteristics and Outcomes Comparison Amongst COVID-19 Positive Intubated, Non-Intubated and COVID-19 Negative Intubated Patients; Single Center, Retrospective Study

Abstract

RATIONALE: With over 1.6 million deaths worldwide, COVID-19 was declared a global pandemic. Many counties facing second wave of infection, hence an urgent need for early identification and therapeutic modalities. Methods: Retrospective study, included 245 patients, over 18 years admitted to Garnet Health Medical Center with confirmed COVID-19 results from March 2020 to May 2020. Further classified into 3 groups;COVID-19 positive and intubated, COVID-19 negative and intubated and COVID-19 positive and non-intubated. Information collected included demographics: age, sex, race, comorbidities;inflammatory markers and treatment modalities. Primary outcome for mortality, ventilator duration, ICU and length of hospital stays were compared. Statistical analysis was done by one-way ANOVA;statistical significance defined by P less than 0 .05. Results: 245 patients were analyzed;105 COVID-19 positive and intubated, 115 COVID-19 negative and intubated and 25 COVID-19 positive and non-intubated groups. Mean age was 60.45, 63.22 and 65.96 with male predominance 72.38%, 53.04% and 60% respectively. Caucasians seemed more affected 53.33%, 73.91% and 40% followed by African Americans. Chronic medical conditions included hypertension (63.80%, 68.69% and 84%), diabetes mellitus (44.76%, 34.78% and 48%) and asthma (13.33%, 10.43% and 8%) respectively. Mortality was 45.71%, 34.23% and 16%. COVID-19 positive patients were intubated for a mean duration of 22.14 days compared to 8.69 days in COVID-19 negative patients. Mean ICU and hospital length of stay were 16.01 and 23.7 days in COVID-19 positive intubated patients, 8.83 and 11.25 days in COVID-19 negative intubated patients, while mean ICU and hospital durations were 2.84 and 12.12 days in COVID-19 positive non-intubated patients;P = 0.0001. Acute Respiratory Distress Syndrome (ARDS), in COVID-19 positive intubated patients (82.85%), acute kidney injury (AKI) (80%) with 32.38 % needing continuous renal replacement therapy (CRRT). While in COVID-19 negative intubated patients 66.95% developed AKI with 17.3 % needing CRRT and only 5.21% patient developed ARDS. COVID-19 positive non-intubated patients AKI was predominant in 64% with no CRRT and 28% developed ARDS. Inflammatory markers were also significantly elevated in COVID-19 positive intubated patients comparatively. In addition, 53 (50.47%) patients received Tocilizumab, 10 (9.52%) received Remdesivir in COVID-19 positive intubated group. While 6 (24%) and 1 (4%) received Tocilizumab and Remdesivir respectively, in COVID-19 positive non-intubated group. Conclusion: COVID-19 positive intubated patients had greater mortality, ventilator duration, length of ICU and hospital stays. This study identified risk factors and complications that may be associated in COVID-19. Early identification, supportive therapies and medications may improve outcome.