Prognostic Factors and Predictors of In-Hospital Mortality Among COVID-19 Patients Admitted to the Intensive Care Unit: An Aid for Triage, Counseling, and Resource Allocation.

Waleed Burhamah,May Alduwailah,Razan Alhunaidi,Sameera Shuaibi,Iman Qahi,Melinda Oroszlányová,Zahraa Mohammad,Maryam Alhenaidi

doi:10.7759/cureus.16577

Abstract

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains today a global health pandemic. Those with severe infection are at risk of rapid clinical deterioration; as a result, intensive care unit (ICU) admission is not uncommon in such patients. A number of determinants have been identified as predictors of poor prognosis and in-hospital mortality, ranging from demographic characteristics, laboratory and/or radiological findings.Aim: To identify determinants of in-hospital mortality and examine the accuracy of seven early warning scores in predicting in-hospital mortality.Methods: This is a retrospective study conducted in Kuwait from July 2020 to March 2021, and participants were adult patients with a positive test on the real-time polymerase chain reaction (RT-PCR) for SARS-CoV-2 and who met the criteria for ICU admission. Data collected included: demographics, clinical status on hospital arrival, laboratory test results, and ICU course. Furthermore, we calculated seven early warning scores for each of our patients.Results: A total of 133 patients were admitted to our COVID-19 ICU with a median age of 59 years. Arrival to ICU on mechanical ventilation (MV), developing in-hospital complications, having chronic kidney disease (CKD), having a high white blood count (WBC), lactate dehydrogenase (LDH), lactate, or urea levels were found to be significant predictors of in-hospital mortality. Furthermore, the 4C mortality score for COVID-19, VACO index for COVID-19 mortality, and the PRIEST COVID-19 clinical severity score proved to be the most superior in predicting in-hospital mortality.Conclusion: Identifying high-risk patients and those with a poor prognosis allows for efficient triaging and the delivery of high-standard care while minimizing the strain on the healthcare system.

Highlights

In December 2019, a cluster of cases of pneumonia of unknown etiology was reported in the City of Wuhan, China
This is a retrospective study conducted in Kuwait from July 2020 to March 2021, and participants were adult patients with a positive test on the real-time polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome (SARS)-CoV-2 and who met the criteria for intensive care unit (ICU) admission
The majority (65%) were transferred from the COVID-19 wards after deteriorating and only 35% were directly admitted to ICU from the emergency department (ED)

Summary

Introduction

In December 2019, a cluster of cases of pneumonia of unknown etiology was reported in the City of Wuhan, China. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) was identified as the culprit It remains today a global health pandemic responsible for more than 3 million deaths worldwide [1]. Various incubation periods have been reported by numerous studies, a period of 2 to 14 days seems to be the general consensus [4,5] It manifests as a syndrome with diverse symptomatology and a spectrum of severities, ranging from being asymptomatic or merely a flu-like illness to as devastatingly as respiratory failure, septic shock, multiple organ dysfunction, and death [6,7]. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains today a global health pandemic Those with severe infection are at risk of rapid clinical deterioration; as a result, intensive care unit (ICU) admission is not uncommon in such patients. A number of determinants have been identified as predictors of poor prognosis and in-hospital mortality, ranging from demographic characteristics, laboratory and/or radiological findings

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