Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study.

Muhammed Elhadi,Ahmed Msherghi,Abdulmueti Alhadi,Muhannud Binnawara,Kamel Alshorbaji,Ahmed Zaid,Marwa Gamra,Samer Khel,Abdurraouf Abusalama,Ala Khaled,Mohammed Elmugassabi,Taha Abubaker,Mohamed Anaiba,Mohammed Abdelkabir,Ahmed Alsoufi,Saedah Abdeewi,Emad Amkhatirah,Akram Alkaseek,Mohammed Huwaysh,Mohammed Abdo Yahya ,Alsnosy Abdullah Khalefa Mohammed

doi:10.1371/journal.pone.0251085

Abstract

BackgroundThe coronavirus disease (COVID-19) pandemic has severely affected African countries, specifically the countries, such as Libya, that are in constant conflict. Clinical and laboratory information, including mortality and associated risk factors in relation to hospital settings and available resources, about critically ill patients with COVID-19 in Africa is not available. This study aimed to determine the mortality and morbidity of COVID-19 patients in intensive care units (ICU) following 60 days after ICU admission, and explore the factors that influence in‐ICU mortality rate.MethodsThis is a multicenter prospective observational study among COVID-19 critical care patients in 11 ICUs in Libya from May 29th to December 30th 2020. Basic demographic data, clinical characteristics, laboratory values, admission Sequential Organ Failure Assessment (SOFA) score, quick SOFA, and clinical management were analyzed.ResultWe included 465 consecutive COVID-19 critically ill patients. The majority (67.1%) of the patients were older than 60 years, with a median (IQR) age of 69 (56.5–75); 240 (51.6%) were male. At 60 days of follow-up, 184 (39.6%) were discharged alive, while 281 (60.4%) died in the intensive care unit. The median (IQR) ICU length of stay was 7 days (4–10) and non-survivors had significantly shorter stay, 6 (3–10) days. The body mass index was 27.9 (24.1–31.6) kg/m2. At admission to the intensive care unit, quick SOFA median (IQR) score was 1 (1–2), whereas total SOFA score was 6 (4–7). In univariate analysis, the following parameters were significantly associated with increased/decreased hazard of mortality: increased age, BMI, white cell count, neutrophils, procalcitonin, cardiac troponin, C-reactive protein, ferritin, fibrinogen, prothrombin, and d-dimer levels were associated with higher risk of mortality. Decreased lymphocytes, and platelet count were associated with higher risk of mortality. Quick SOFA and total SOFA scores increase, emergency intubation, inotrope use, stress myocardiopathy, acute kidney injury, arrythmia, and seizure were associated with higher mortality.ConclusionOur study reported the highest mortality rate (60.4%) among critically ill patients with COVID-19 60 days post-ICU admission. Several factors were found to be predictive of mortality, which may help to identify patients at risk of mortality during the ongoing COVID-19 pandemic.

Highlights

Since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019, the coronavirus disease (COVID-19) has affected more than 137 million people and has resulted in the death of more than 2.96 million patients by April 14th, 2021 [1]
Our study reported the highest mortality rate (60.4%) among critically ill patients with COVID-19 60 days post-intensive care units (ICU) admission
Median laboratory values were significantly different between survivors and non-survivors; white blood cells, neutrophils, procalcitonin, cardiac troponin, ferritin, fibrinogen, prothrombin, and D-dimer levels were higher in non-survivors than in survivors, while lymphocyte counts and platelet counts were significantly lower in non-survivors than in survivors

Summary

Introduction

Since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019, the coronavirus disease (COVID-19) has affected more than 137 million people and has resulted in the death of more than 2.96 million patients by April 14th, 2021 [1]. The major cause of morbidity and mortality in COVID-19 is the evolution of acute respiratory distress syndrome (ARDS) and multi-organ dysfunction [2,3,4]. Several factors, such as increasing age, presence of other comorbidities, and abnormalities in specific laboratory results, have been identified as risk factors for COVID-19 severity [5]. This study aimed to determine the mortality and morbidity of COVID-19 patients in intensive care units (ICU) following 60 days after ICU admission, and explore the factors that influence in-ICU mortality rate

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