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

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