Abstract
ABSTRACTObjective:To describe clinical characteristics, resource use, outcomes, and to identify predictors of in-hospital mortality of patients with COVID-19 admitted to the intensive care unit.Methods:Retrospective single-center cohort study conducted at a private hospital in São Paulo (SP), Brazil. All consecutive adult (≥18 years) patients admitted to the intensive care unit, between March 4, 2020 and February 28, 2021 were included in this study. Patients were categorized between survivors and non-survivors according to hospital discharge.Results:During the study period, 1,296 patients [median (interquartile range) age: 66 (53-77) years] with COVID-19 were admitted to the intensive care unit. Out of those, 170 (13.6%) died at hospital (non-survivors) and 1,078 (86.4%) were discharged (survivors). Compared to survivors, non-survivors were older [80 (70-88) versus 63 (50-74) years; p<0.001], had a higher Simplified Acute Physiology Score 3 [59 (54-66) versus 47 (42-53) points; p<0.001], and presented comorbidities more frequently. During the intensive care unit stay, 56.6% of patients received noninvasive ventilation, 32.9% received mechanical ventilation, 31.3% used high flow nasal cannula, 11.7% received renal replacement therapy, and 1.5% used extracorporeal membrane oxygenation. Independent predictors of in-hospital mortality included age, Sequential Organ Failure Assessment score, Charlson Comorbidity Index, need for mechanical ventilation, high flow nasal cannula, renal replacement therapy, and extracorporeal membrane oxygenation support.Conclusion:Patients with severe COVID-19 admitted to the intensive care unit exhibited a considerable morbidity and mortality, demanding substantial organ support, and prolonged intensive care unit and hospital stay.
Highlights
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide.[1]
OR: odds ratio; 95%CI: 95% confidence interval; SAPS 3: Simplified Acute Physiology Score 3; SOFA score: Sequential Organ Failure Assessment score; MFI: modified frailty index; COPD: chronic obstructive pulmonary disease; RRT: renal replacement therapy; ICU: intensive care unit; AKI: acute kidney injury according; ECMO: extracorporeal membrane oxygenation. In this retrospective single center cohort study, we found that one in seven patients admitted to the ICU due to severe COVID-19 infection died at the hospital
The association between advanced age and increased risk of death in patients infected with SARS-CoV-2 has been reported by different authors.[3,26,27,28] the association between the presence of comorbidities and the severity of COVID-19 was evidenced in several studies.[9,26,29,30] For instance, COVID-19 patients with hypertension, cardiocerebrovascular diseases, and diabetes mellitus were at higher risk of developing severe symptoms, and requiring ICU admission than patients without these comorbidities.[30] we observed that locoregional cancer diagnosis was more prevalent in deceased patients in comparison with survivors
Summary
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide.[1] most of the infected patients develop only mild symptoms, approximately 15% of symptomatic patients will require hospitalization,(2) and almost 20% of hospitalized patients will require intensive care unit (ICU) admission due to progression to acute respiratory failure (ARF).(3,4). Male sex, obesity, systemic hypertension, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and cardiovascular disease are major risk factors for severe COVID-19.(5-8) Critically ill patients with COVID-19 require substantial organ support. 37 were open medical-surgical adult ICU beds and 81 were adult stepdown unit beds. During the first year of the COVID-19 pandemic, the total ICU operational capacity was increased, reaching 81 ICU beds designated to support severe COVID-19 patients requiring intensive care
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