Evaluation of Patients Treated in Intensıve Care Due to COVID-19: A Retrospective Study
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Background: The aim of this study is to report the demographic characteristics, clinical features, treatment protocols, comorbidities, imaging findings, prognosis and factors affecting mortality in critically ill patients with coronavirus disease 2019 (COVID-19) in the intensive care unit. Materials and methods: This retrospective cohort study consists of adult (≥18 years old) patients hospitalized in a tertiary hospital intensive care unit of with COVID-19. The independent effects of possible factors identified in previous analyzes on survival were analyzed using univariate and multivariate logistic regression analysis. Results: The mean age of all patients was 70.2 ± 13.9 years. Of the 200 patients, 139 (69.5%) had died. White blood cells (19.2 ± 76.1 × 109 per L), neutrophil/lymphocyte ratio (15.4 ± 65.1), d-dimer (2,558.4 ± 4,574.2 ng/mL), ferritin (1,481.2 ± 4,447.4 μg/L) and C-reactive protein (CRP) (12.1 ± 11.9 mg/dL) levels were high at the time of admission. According to the results of univariate regression analysis; presence of additional disease (odds ratio [OR]: 3.837; P = 0.015), older age (OR: 1.027; P = 0.015), reverse transcriptase-polymerase chain reaction (RT-PCR) positivity (OR: 2.58; P = 0.019), higher heart rate (OR = 1.027; P = 0.028), higher APACHE II score (OR: 1.049; P = 0.012), higher sequential organ failure assessement (SOFA) score(OR: 1.479; P = 0.014), high d-dimer levels (OR: 3.180; P <0.001) and high CRP levels (OR: 1.035; P = 0.028) increases the risk of death. When patients with full data for all variables in the multivariate logistic regression model were evaluated; positive RT-PCR (OR=4.105; P = 0.005), older age (OR: 1.033; P = 0.024), higher heart rate (OR: 1.042; P = 0.006), higher (SOFA) score (OR: 1.477; P <0.001), high d-dimer levels at admission (OR: 3.459; P = 0.002) and diabetes mellitus (OR: 3.433; P = 0.035) increase the risk of death. Conclusion: Mortality of critically ill patients with COVID-19 pneumonia was high (69.5%). Older patients and acute respiratory distress syndrome were at higher risk of death. High SOFA score, high d-dimer at admission, and presence of diabetes mellitus were associated with high mortality.
Abstract
Background: The aim of this study is to report the demographic characteristics, clinical features, treatment protocols, comorbidities, imaging findings, prognosis and factors affecting mortality in critically ill patients with coronavirus disease 2019 (COVID-19) in the intensive care unit. Materials and methods: This retrospective cohort study consists of adult (≥18 years old) patients hospitalized in a tertiary hospital intensive care unit of with COVID-19. The independent effects of possible factors identified in previous analyzes on survival were analyzed using univariate and multivariate logistic regression analysis. Results: The mean age of all patients was 70.2 ± 13.9 years. Of the 200 patients, 139 (69.5%) had died. White blood cells (19.2 ± 76.1 × 109 per L), neutrophil/lymphocyte ratio (15.4 ± 65.1), d-dimer (2,558.4 ± 4,574.2 ng/mL), ferritin (1,481.2 ± 4,447.4 μg/L) and C-reactive protein (CRP) (12.1 ± 11.9 mg/dL) levels were high at the time of admission. According to the results of univariate regression analysis; presence of additional disease (odds ratio [OR]: 3.837; P = 0.015), older age (OR: 1.027; P = 0.015), reverse transcriptase-polymerase chain reaction (RT-PCR) positivity (OR: 2.58; P = 0.019), higher heart rate (OR = 1.027; P = 0.028), higher APACHE II score (OR: 1.049; P = 0.012), higher sequential organ failure assessement (SOFA) score(OR: 1.479; P = 0.014), high d-dimer levels (OR: 3.180; P <0.001) and high CRP levels (OR: 1.035; P = 0.028) increases the risk of death. When patients with full data for all variables in the multivariate logistic regression model were evaluated; positive RT-PCR (OR=4.105; P = 0.005), older age (OR: 1.033; P = 0.024), higher heart rate (OR: 1.042; P = 0.006), higher (SOFA) score (OR: 1.477; P <0.001), high d-dimer levels at admission (OR: 3.459; P = 0.002) and diabetes mellitus (OR: 3.433; P = 0.035) increase the risk of death. Conclusion: Mortality of critically ill patients with COVID-19 pneumonia was high (69.5%). Older patients and acute respiratory distress syndrome were at higher risk of death. High SOFA score, high d-dimer at admission, and presence of diabetes mellitus were associated with high mortality.
참고문헌 (36)
- "WHO coronavirus (COVID-19) dashboard"[URL]
- Wang D, "Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China", JAMA, 323, pp.1061~1069 (2020)
- Zhu N, "A novel coronavirus from patients with pneumonia in China, 2019", N Engl J Med, 382, pp.727~733 (2020)
- Zhou F, "Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China : a retrospective cohort study", Lancet, 395, pp.1054~1062 (2020)
- Möhlenkamp S, "Ventilation of COVID-19 patients in intensive care units", Herz, 45, pp.329~331 (2020)
- Collantes MEV, "Neurological manifestations in COVID-19 infection : A systematic review and meta-analysis", Can J Neurol Sci, 48, pp.66~76 (2021)
- Helms J, "High risk of thrombosis in patients with severe SARS-CoV-2infection : a multicenter prospective cohort study", Intensive Care Med, 46, pp.1089~1098 (2020)
- Richardson S, "Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area", JAMA, 323, pp.2052~2059 (2020)
- Guo T, "Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019(COVID-19)", JAMA Cardiol, 5, pp.811~818 (2020)
- Moore JB, "Cytokine release syndrome in severe COVID-19", Science, 368, pp.473~474 (2020)
- Wong HYF, "Frequency and distribution of chest radiographic findings in patients positive for COVID-19", Radiology, 296, pp.E72~E78 (2020)
- Alhazzani W, "Surviving Sepsis Campaign : guidelines on the management of critically ill adults with coronavirus disease 2019(COVID-19)", Intensive Care Med, 46, pp.854~887 (2020)
- "COVID-19 bilgilendirme platformu"[URL]
- Grasselli G, "Baseline characteristics and outcomes of 1591patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy", JAMA, 323, pp.1574~1581 (2020)
- Gupta S, "STOP-COVID Investigators. Factors associated with death in critically ill patients with coronavirus disease 2019 in the US", JAMA Intern Med, 180, pp.1436~1447 (2020)
- Pouw N, "Clinical characteristics and outcomes of 952 hospitalized COVID-19 patients in The Netherlands : A retrospective cohort study", PLoS One, 16, pp.e0248713~ (2021)
- Corona G, "Diabetes is most important cause for mortality in COVID-19 hospitalized patients : Systematic review and meta-analysis", Rev Endocr Metab Disord, 22, pp.275~296 (2021)
- McGurnaghan SJ, "Risks of and risk factors for COVID-19 disease in people with diabetes : a cohort study of the total population of Scotland", Lancet Diabetes Endocrinol, 9, pp.82~93 (2021)
- Yao Y, "D-dimer as a biomarker for disease severity and mortality in COVID-19 patients : a case control study", J Intensive Care, 8, pp.49~ (2020)
- Zhang L, "D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19", J Thromb Haemost, 18, pp.1324~1329 (2020)
- Kocayiğit H, "Characteristics and outcomes of critically ill patients with covid-19 in Sakarya, Turkey : a single centre cohort study", Turk J Med Sci, 51, pp.440~447 (2021)
- Taylor EH, "Factors associated with mortality in patients with COVID-19admitted to intensive care : a systematic review and meta-analysis", Anaesthesia, 76, pp.1224~1232 (2021)
- Burrell AJ, "Outcomes for patients with COVID-19 admitted to Australian intensive care units during the first four months of the pandemic", Med J Aust, 214, pp.23~30 (2021)
- Zou X, "Acute physiology and chronic health evaluation II score as a predictor of hospital mortality in patients of coronavirus disease 2019", Crit Care Med, 48, pp.e657~e665 (2020)
- Yang X, "Acute kidney injury and renal replacement therapy in COVID-19 patients : A systematic review and meta-analysis", Int Immunopharmacol, 90, pp.107159~ (2021)
- Gupta S, "AKI treated with renal replacement therapy in critically ill patients with COVID-19", J Am Soc Nephrol, 32, pp.161~176 (2021)
- Doher MP, "Acute kidney injury and renal replacement therapy in critically ill COVID-19patients : Risk factors and outcomes : A single-center experience in Brazil", Blood Purif, 50, pp.520~530 (2021)
- Ramírez P, "Acute respiratory distress syndrome due to COVID-19. Clinical and prognostic features from a medical critical care unit in Valencia, Spain", Med Intensiva(Engl Ed), 45, pp.27~34 (2021)
- Bhatraju PK, "Covid-19 in critically ill patients in the Seattle region-Case series", N Engl J Med, 382, pp.2012~2022 (2020)
- Larsson E, "Characteristics and outcomes of patients with COVID-19 admitted to ICU in a tertiary hospital in Stockholm, Sweden", Acta Anaesthesiol Scand, 65, pp.76~81 (2021)
- Zhao J, "Antibody responses to SARS-CoV-2 in patients with novel coronavirus disease 2019", Clin Infect Dis, 71, pp.2027~2034 (2020)
- De Smet K, "Diagnostic performance of chest CT for SARS-CoV-2 infection in individuals with or without COVID-19 symptoms", Radiology, 298, pp.E30~E37 (2021)
- Yang X, "Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China : a single-centered, retrospective, observational study", Lancet Respir Med, 8, pp.475~481 (2020)
- Huang C, "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China", Lancet, 395, pp.497~506 (2020)
- Serafim RB, "Clinical course and outcomes of critically ill patients with COVID-19 infection : a systematic review", Clin Microbiol Infect, 27, pp.47~54 (2021)
- Armstrong RA, "Mortality in patients admitted to intensive care with COVID-19 : an updated systematic review and meta-analysis of observational studies", Anaesthesia, 76, pp.537~548 (2021)