Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 25 , ISSUE 9 ( September, 2021 ) > List of Articles

Original Article

Clinical Characteristics and Outcomes of COVID-19 Patients Hospitalized in Intensive Care Unit

Rahul A Pandit, BN Gagana, Charudatt Vaity, Jitendra S Choudhary, Vivek Jain, Pramila M Chandan, Harsh Joshi

Keywords : COVID-19, ICU, Outcomes

Citation Information : Pandit RA, Gagana B, Vaity C, Choudhary JS, Jain V, Chandan PM, Joshi H. Clinical Characteristics and Outcomes of COVID-19 Patients Hospitalized in Intensive Care Unit. Indian J Crit Care Med 2021; 25 (9):992-1000.

DOI: 10.5005/jp-journals-10071-23945

License: CC BY-NC 4.0

Published Online: 08-09-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Background: Meta-analysis and clinical studies suggest coronavirus disease-2019 (COVID-19) patients in ICU have a high mortality rate of 30–45%, which has evolved as a function of criteria of admission and the management modalities. Materials and methods: We conducted a retrospective evaluation for characteristics and outcomes in critical care set up across six months. Results: 514 patients (74.3% males and 25.6% females) were evaluated. 9.72% (n = 50) patients expired, 78% (n = 39) were males. Mean age (years) was 57 (±14, range 64, 95% CI 55–58). 65.7% (n = 338) were of age more than 50 years, of which 71.5% (n = 242) were males. Males at 20% higher risk for death than women. (RR = 1.2, 95% CI 0.66–2.31, p = 0.61 NS). There was 18% less risk of mortality in female vs male with comorbidities (RR 0.82, 95% CI 0.67–1.12, p = 0.32 NS). Risk for mortality in diabetics was significantly increased by 116% vs nondiabetics. (RR 2.16, p = 0.0055, 95% CI 1.28–3.67). Highly significant risk of mortality in age group >50 years (3.13 times higher) vs age ≤50 years. (RR 3.18, 95% CI 1.71–8.64, p = 0.0003). 50.2% had moderate ARDS at admission. High flow nasal cannula was used in 47.2%. There is 5.79 times more likelihood to be on the ventilator with moderate to severe ARDS vs mild ARDS (RR = 5.79, 95% CI 3.10–11.05, p <0.0001). Risk for death was six times higher for patients on ventilator vs not on ventilator (RR = 6.08, 95% CI 3.49–10.59, p <0.0001). The mean number of days on ventilator for patients who underwent tracheostomy (n = 49) was 14 days as compared to 6.6 days in patients who were extubated (n = 57) (p <0.0001). P/F ratio had negative correlation with number of days of hospitalisation (Pearson r -0.391, 95% CI -0.46– -0.31, p <0.0001). 67% less chances of mortality in patients on steroids (RR = 0.33, 95% CI 0.19–60, p = 0.0012). Mean duration of ICU stay (days) was 8 (± 5, range 29, 95% CI 7.5–8.4). Conclusions: We observed that a strict adherence to the basic principles of ARDS management resulted in a lower mortality in ICU setting.


HTML PDF Share
  1. Chalmers JD, Crichton ML, Goeminne PC, Cao B, Humbert M, Shteinberg M, et al. Management of hospitalised adults with coronavirus disease-19 (COVID-19): a European Respiratory Society living guideline. Eur Respir J 2021;57(4):2100048. DOI: 10.1183/13993003. 00048-2021.
  2. Sarma P, Bhattacharyya A, Kaur H, Prajapat M, Prakash A, Kumar S, et al. Efficacy and safety of steroid therapy in COVID-19: A rapid systematic review and Meta-analysis. Indian J Pharmacol 2020;52(6):535–550. DOI: 10.4103/ijp.ijp_1146_20.
  3. Zhan Y, Shang J, Gu Y, Huang Q, Xie J. Efficacy of corticosteroid in patients with COVID-19: a multi-center retrospective study and meta-analysis. J Med Virol 2021;93(7):4292–4302. DOI: 10.1002/jmv.26914.
  4. Macedo A, Gonçalves N, Febra C. COVID-19 fatality rates in hospitalized patients: systematic review and meta-analysis. Ann Epidemiol 2021;57:14–21. DOI: 10.1016/j.annepidem.2021.02.012.
  5. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA 2012;307(23):2526–2533. DOI: 10.1001/jama.2012.5669.
  6. Abate SM, Ahmed Ali S, Mantfardo B, Basu B. Rate of Intensive Care Unit admission and outcomes among patients with coronavirus: a systematic review and meta-analysis. PLoS One 2020;15(7):e0235653. DOI: 10.1371/journal.pone.0235653.
  7. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382(18):1708–1720. DOI: 10.1056/NEJMoa2002032.
  8. Sun H, Ning R, Tao Y, Yu C, Deng X, Zhao C, et al. Risk factors for mortality in 244 older adults with COVID-19 in Wuhan, China: a retrospective study. J Am Geriatr Soc 2020;68(6):E19–E23. DOI: 10.1111/jgs.16533.
  9. Gebhard C, Regitz-Zagrosek V, Neuhauser HK, Morgan R, Klein SL. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ 2020;11(1):1–3. DOI: 10.1186/s13293-020-00304-9.
  10. Jj Z, Dong X, Yd Y, Yq Y. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy 2020;75(7):1730–1741. DOI: 10.1111/all.14238.
  11. Yang X, Yu Y, Xu J. 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 2020;8(5):P475–P481. DOI: 10.1016/S2213-2600(20)30079-5.
  12. Gemmati D, Bramanti B, Serino ML, Secchiero P, Zauli G, Tisato V. COVID-19 and individual genetic susceptibility/receptivity: role of ACE1/ACE2 genes, immunity, inflammation and coagulation. Might the double X-chromosome in females be protective against SARS-CoV-2 compared to the single X-chromosome in males? Int J Mol Sci 2020;21(10):3474. DOI: 10.3390/ijms21103474.
  13. Olds JL, Kabbani N. Is nicotine exposure linked to cardiopulmonary vulnerability to COVID-19 in the general population? FEBS J 2020 [in press]. DOI: 10.1111/febs.15303.
  14. Singh AK, Gupta R, Ghosh A, Misra A. Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr 2020;14(4):303–310. DOI: 10.1016/j.dsx.2020.04.004.
  15. Muniyappa R, Gubbi S. COVID-19 pandemic, coronaviruses, and diabetes mellitus. Am J Physiol Endocrinol Metab 2020;318(5): E736–E741. DOI: 10.1152/ajpendo.00124.2020.
  16. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis 2020;12. DOI: 10.1016/j.ijid.2020.03.017. PII: S1201-9712(20)30136-3.
  17. Turner JM, Kodali R. Should angiotensin-converting enzyme inhibitors ever be used for the management of hypertension? Curr Cardiol Rep 2020;22(9):95. DOI: 10.1007/s11886-020-01352-8.
  18. Long B, Brady WJ, Koyfman A, Gottlieb M. Cardiovascular complications in COVID-19. Am J Emerg Med 2020;38(7):1504–1507. DOI: 10.1007/s11886-020-01352-8. PMID: 32648000; PMCID: PMC7344347.
  19. Lazaridis C, Vlachogiannis NI, Bakogiannis C, Spyridopoulos I, Stamatelopoulos K, Kanakakis I, et al. Involvement of cardiovascular system as the critical point in coronavirus disease 2019 (COVID-19) prognosis and recovery. Hellenic J Cardiol 2020;61(6):381–395. DOI: 10.1016/j.hjc.2020.05.004.
  20. Wu F, Zhou Y, Wang Z, Xie M, Shi Z, Tang Z, et al. Clinical characteristics of COVID-19 infection in chronic obstructive pulmonary disease: a multicenter, retrospective, observational study. J Thorac Dis 2020;12(5):1811. DOI: 10.21037/jtd-20-1914. PMID: 32642086; PMCID: PMC7330323.
  21. D'Marco L, Puchades MJ, Romero-Parra M, Gimenez-Civera E, Soler MJ, Ortiz A, et al. Coronavirus disease 2019 in chronic kidney disease. Clin Kidney J 2020;13(3):297–306. DOI: 10.1093/ckj/sfaa104. PMID: 32699615; PMCID: PMC7367105.
  22. Armstrong RA, Kane AD, Cook TM. Outcomes from intensive care in patients with COVID-19: a systematic review and meta-analysis of observational studies. Anaesthesia 2020;75(10):1340–1349. DOI: 10.1111/anae.15201.
  23. Nitsure M, Sarangi B, Shankar GH, Reddy VS, Walimbe A, Sharma V, et al. Mechanisms of hypoxia in COVID-19 patients: a pathophysiologic reflection. Indian J Crit Care Med 2020;24(10):967–970. DOI: 10.5005/jp-journals-10071-23547.
  24. Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368(23):2159–2168. DOI: 10.1056/NEJMoa1214103.
  25. Coppo A, Bellani G, Winterton D, Di Pierro M, Soria A, Faverio P, et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. Lancet Respir Med 2020;8(8):765–774. DOI: 10.1016/S2213-2600(20)30268-X. PMID: 32569585; PMCID: PMC7304954.
  26. Simioli F, Annunziata A, Langella G, Martino M, Musella S, Fiorentino G. Early prone positioning and non-invasive ventilation in a critical COVID-19 subset. a single centre experience in Southern Italy. Turk Thorac J 2021;22(1):57–61. DOI: 10.5152/TurkThoracJ.2021.20158.
  27. Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ 2020;369:m1985. DOI: 10.1136/bmj.m1985.
  28. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020;323(20):2052–2059. DOI: 10.1001/jama.2020.6775.
  29. Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – a systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr 2020;14(4):395–403. DOI: 10.1016/j.dsx. 2020.04.018.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.