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COVID-19 Clinical Outcomes

COVID-19 Patients and ICU Outcomes in Italy: Respiratory Findings and Mortality

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BACKGROUND AND PURPOSE:

  • Grasselli et al (JAMA, 2020) described the baseline characteristics and outcomes of patients with COVID-19 requiring ICU admission

METHODS:

  • Retrospective case series (February 20 and March 18, 2020) | Final date of follow-up was March 25, 2020
  • Setting
    • ICUs in Lombardy, Italy
  • Participants
    • Consecutive patients with confirmed COVID-19 referred for ICU admission
  • Study design
    • COVID-19 was confirmed with RT-PCR of nasal and pharyngeal swabs
    • Patient demographic and clinical data were collected including
      • Clinical management
      • Respiratory failure
      • Patient mortality

RESULTS:

  • 1591 patients
    • Median age: 63 years (IQR 56 to 70) | 82% male
  • Comorbidity data available: 1043 patients
    • ≥1 comorbidity: 68%
    • Hypertension: 49%
    • Hypertension most common comorbidity, followed by cardiovascular disorders, hypercholesterolemia, and diabetes | Pulmonary disease was present in the cohort, but relatively uncommon

Respiratory Support Findings

  • Respiratory support required: 99% of patients (95% CI, 98% to 99%)
    • Required mechanical ventilation: 88% (95% CI, 87% to 90%)
    • Required noninvasive ventilation: 11% (95% CI, 9% to 12%)
  • There was no difference in PEEP requirements based on age (P = 0.94) | Median PEEP: 14 cm H2O (IQR, 12 to 16)
    • ≤63 years: 14 cm H2O (IQR, 12 to 15)
    • ≥64 years: 14 cm H2O (IQR, 12-16)
  • Median FiO2 was lower in younger patients (P = 0.006)
    • ≤63 years: 60% (IQR, 50% to 80%)
    • ≥64 years: 70% (IQR, 50% to 80%)
  • Median PaO2/FiO2 was higher in younger patients (P = 0.02)
    • ≤63 years: 163.5 (IQR, 120 to 230)
    • ≥64 years: 156 (IQR, 110 to 205)

Hypertension

  • Patients with hypertension were older than those without hypertension (P < 0.001) and had lower Pao2/Fio2 (P = 0.005)
    • Median age
      • Hypertension: 66 years (IQR 60 to 72)
      • Without hypertension: 62 years (IQR 54 to 68)
    • Median PaO2/FiO2
      • Hypertension: 146 (IQR 105 to214)
      • Without hypertension: 173 (IQR 120 to 222)

Patient Outcomes

  • Still in ICU: 58% (95% CI, 56%to 61%)
  • Discharged from ICU: 16% (95% CI, 14% to 18%)
  • Died in ICU: 26% (95% CI, 23% to 28%)
  • Mortality was higher in older patients (P < 0.001)
    • ≥64 years: 36%
    • ≤63 years: 15%

CONCLUSION:

  • In this study, COVID-19 patients in ICUs in Lombardy, Italy were mostly older men | Most patients in the ICU required mechanical ventilation, with high levels of PEEP
  • Approximately a quarter of patients died following admission to the ICU
    • Many patients still remained hospitalized
  • The authors point out that age of median age of ICU admission was 63 years, similar to the median age of COVID-19 positive cases in Italy “suggesting that, to date, older age alone is not a risk factor for admission to the ICU”

Learn More – Primary Sources:

Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

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Related ObG Topics:

COVID-19 in Italy: Why is the Case Fatality Rate So High?
MMWR Reports on Initial US COVID-19 Experience: Demographics, Mortality and Outcomes 
Washington State’s First COVID-19 Cases: Outcomes and Characteristics of 21 Critically Ill Patients

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