Clinical features and prognostic factors of intensive and non-intensive 1014 COVID-19 patients: an experience cohort from Alahsa, Saudi Arabia

Saad Alhumaid,Ahmed Omar,Hatim S Ahmed,Ali M Al Ghazal,Hanan Al Shaikh,Dayas K Philip,Jaffar A Al‐Tawfiq ,Zainab Al Alawi,Mossa Alismail,Mahdi Bu Jubarah,Maher M Al Mahdi,Mohammed Alyousef ,Ali A Rabaan,Alyaa Elhazmi,Abbas Al Mutair,Salamah A Alomran,Haifa Al-Shammari,Sarah Y Alsabati,Maitham S Al Athan,Khulud Al Salman,Abdulsatar H Al Brahim,Nourah Al Dossary,Awad Al‐Omari

doi:10.1186/s40001-021-00517-7

Abstract

BackgroundCOVID-19 is a worldwide pandemic and has placed significant demand for acute and critical care services on hospitals in many countries.ObjectivesTo determine the predictors of severe COVID-19 disease requiring admission to an ICU by comparing patients who were ICU admitted to non-ICU groups.MethodsA cohort study was conducted for the laboratory-confirmed COVID-19 patients who were admitted to six Saudi Ministry of Health’s hospitals in Alahsa, between March 1, 2020, and July 30, 2020, by reviewing patient’s medical records retrospectively.ResultsThis cohort included 1014 patients with an overall mean age of 47.2 ± 19.3 years and 582 (57%) were males. A total of 205 (20%) of the hospitalized patients were admitted to the ICU. Hypertension, diabetes and obesity were the most common comorbidities in all study patients (27.2, 19.9, and 9%, respectively). The most prevalent symptoms were cough (47.7%), shortness of breath (35.7%) and fever (34.3%). Compared with non-ICU group, ICU patients had older age (p ≤ 0.0005) and comprised a higher proportion of the current smokers and had higher respiratory rates (p ≤ 0.0005), and more percentage of body temperatures in the range of 37.3–38.0 °C (p ≥ 0.0005); and had more comorbidities including diabetes (p ≤ 0.0005), hypertension (p ≥ 0.0005), obesity (p = 0.048), and sickle cell disease (p = 0.039). There were significant differences between the non-ICU and ICU groups for fever, shortness of breath, cough, fatigue, vomiting, dizziness; elevated white blood cells, neutrophils, alanine aminotransferase and alkaline aminotransferase, lactate dehydrogenase, and ferritin, and decreased hemoglobin; and proportion of abnormal bilateral chest CT images (p < 0.05). Significant differences were also found for multiple treatments (p < 0.05). ICU patients group had a much higher mortality rate than those with non-ICU admission (p ≤ 0.0005).ConclusionIdentifying key clinical characteristics of COVID-19 that predict ICU admission and high mortality can be useful for frontline healthcare providers in making the right clinical decision under time-sensitive and resource-constricted environment.

Highlights

COVID-19 is a worldwide pandemic and has placed significant demand for acute and critical care ser‐ vices on hospitals in many countries
Identifying key clinical characteristics of COVID-19 that predict Intensive care unit (ICU) admission and high mortality can be useful for frontline healthcare providers in making the right clinical decision under time-sensitive and resourceconstricted environment
We report similar results of previous studies regarding the laboratory abnormalities that have been described in severe COVID-19 patients who necessitated ICU admission including elevated white blood cells [9, 32, 56], neutrophils [9, 32, 56, 57], alanine aminotransferase and aspartate aminotransferase [9, 24, 32, 35, 45, 56, 58], creatinine [9, 32, 35, 43, 45], creatinine kinase [9, 35, 45, 56, 58], lactate dehydrogenase [9, 24, 31, 32, 35, 43, 45, 56, 58, 59], and ferritin [24, 31, 45, 56, 58, 59]

Summary

Introduction

COVID-19 is a worldwide pandemic and has placed significant demand for acute and critical care ser‐ vices on hospitals in many countries. World Health Organization (WHO) has officially named the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease corona virus disease 2019 (COVID-19) [2]. On January 30, 2020, the WHO declared the COVID-19 outbreak a public health emergency of international concern and, in March 2020, began to characterize it as a pandemic, in order to highlight the seriousness of the situation and urge all countries to take action in detecting infection and preventing spread. As of January 5, 2021, the total reported confirmed COVID-19 cases have reached more than 363,259 including more than 6,265 deaths within Saudi Arabia [6]. Studies have shown that up to 20% of the patients infected with SARS-CoV-2 develop high disease severity and need to be hospitalized [7,8,9]. The study describes the clinical characteristics, laboratories features as well as clinical outcomes for ICU and non-ICU hospitalized COVID-19 patients

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