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Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: A prospective, cohort, multicentre study.
Rev Esp Anestesiol Reanim (Engl Ed). 2020 Oct; 67(8):425-437.RE

Abstract

BACKGROUND

The clinical course of COVID-19 critically ill patients, during their admission in the intensive care unit (UCI), including medical and infectious complications and support therapies, as well as their association with in-ICU mortality has not been fully reported.

OBJECTIVE

This study aimed to describe clinical characteristics and clinical course of ICU COVID-19 patients, and to determine risk factors for ICU mortality of COVID-19 patients.

METHODS

Prospective, multicentre, cohort study that enrolled critically ill COVID-19 patients admitted into 30 ICUs from Spain and Andorra. Consecutive patients from March 12th to May 26th, 2020 were enrolled if they had died or were discharged from ICU during the study period. Demographics, symptoms, vital signs, laboratory markers, supportive therapies, pharmacological treatments, medical and infectious complications were reported and compared between deceased and discharged patients.

RESULTS

A total of 663 patients were included. Overall ICU mortality was 31% (203 patients). At ICU admission non-survivors were more hypoxemic [SpO2 with non-rebreather mask, 90 (IQR 83 to 93) vs. 91 (IQR 87 to 94); P<.001] and with higher sequential organ failure assessment score [SOFA, 7 (IQR 5 to 9) vs. 4 (IQR 3 to 7); P<.001]. Complications were more frequent in non-survivors: acute respiratory distress syndrome (ARDS) (95% vs. 89%; P=.009), acute kidney injury (AKI) (58% vs. 24%; P<10-16), shock (42% vs. 14%; P<10-13), and arrhythmias (24% vs. 11%; P<10-4). Respiratory super-infection, bloodstream infection and septic shock were higher in non-survivors (33% vs. 25%; P=.03, 33% vs. 23%; P=.01 and 15% vs. 3%, P=10-7), respectively. The multivariable regression model showed that age was associated with mortality, with every year increasing risk-of-death by 1% (95%CI: 1 to 10, P=.014). Each 5-point increase in APACHE II independently predicted mortality [OR: 1.508 (1.081, 2.104), P=.015]. Patients with AKI [OR: 2.468 (1.628, 3.741), P<10-4)], cardiac arrest [OR: 11.099 (3.389, 36.353), P=.0001], and septic shock [OR: 3.224 (1.486, 6.994), P=.002] had an increased risk-of-death.

CONCLUSIONS

Older COVID-19 patients with higher APACHE II scores on admission, those who developed AKI grades ii or iii and/or septic shock during ICU stay had an increased risk-of-death. ICU mortality was 31%.

Authors+Show Affiliations

Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, España; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España. Electronic address: cafeoranestesia@gmail.com.Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, España.Departamento de Medicina Preventiva y Salud Pública, Escuela Médica, Universidad de Navarra, Pamplona, España.Tecnología Ubikare, Bilbao, Vizcaya, España.Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Río Hortega, Valladolid, España.Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Río Hortega, Valladolid, España.Departamento de Anestesiología y Cuidados Críticos, Hospital del Mar, Barcelona, España.Departamento de Anestesiología y Cuidados Críticos, Hospital del Mar, Barcelona, España.Departamento de Anestesiología y Cuidados Críticos, Hospital La Princesa, Madrid, España.Departamento de Anestesiología y Cuidados Críticos, Hospital Clínica Universidad de Navarra, Pamplona, Navarra, España.Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario La Paz, Madrid, España.Departamento de Anestesiología y Cuidados Críticos, Hospital de Cruces, Barakaldo, Vizcaya, España.Departamento de Anestesiología y Cuidados Críticos, Hospital de Cruces, Barakaldo, Vizcaya, España.Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, España.Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, España.Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, España.Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, España.Unidad de Cuidados Intensivos Médicos, Hospital Clínic, Institut D'investigació August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, España.Unidad Hepática, Hospital Clínic, Universidad de Barcelona, Barcelona, España.Unidad Hepática, Hospital Clínic, Universidad de Barcelona, Barcelona, España.Departamento de Anestesiología y Cuidados Críticos, Hospital del Ramón y Cajal, Madrid, España.Departamento de Anestesiología y Cuidados Críticos, Hospital del Ramón y Cajal, Madrid, España.Departamento de Anestesiología y Cuidados Críticos, Hospital del Universitario Infanta Leonor, Madrid, España.Departamento de Anestesiología y Cuidados Críticos, Hospital del Universitario Infanta Leonor, Madrid, España.Departamento de Anestesiología y Cuidados Críticos, Hospital San Joan Despí Moises Broggi, Barcelona, España.Departamento de Anestesiología y Cuidados Críticos, Hospital San Joan Despí Moises Broggi, Barcelona, España.Departamento de Anestesiología y Cuidados Críticos, Hospital del Mar, Barcelona, España.Departamento de Anestesiología y Cuidados Críticos, Hospital Nostra Senyora de Meritxell SAAS, Andorra, Andorra.Departamento de Anestesiología y Cuidados Críticos, Hospital de Ciudad Real, Ciudad Real, España.Departamento de Anestesiología y Cuidados Críticos, Hospital de Urdúliz, Urdúliz, Vizcaya, España.Departamento de Anestesiología y Cuidados Críticos, Hospital de Terrasa, Terrasa, Barcelona, España.Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario a Coruña, A Coruña, España.Departamento de Anestesiología y Cuidados Críticos, Hospital Sanitas CIMA, Barcelona, España.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng spa

PubMed ID

32800622

Citation

Ferrando, C, et al. "Patient Characteristics, Clinical Course and Factors Associated to ICU Mortality in Critically Ill Patients Infected With SARS-CoV-2 in Spain: a Prospective, Cohort, Multicentre Study." Revista Espanola De Anestesiologia Y Reanimacion, vol. 67, no. 8, 2020, pp. 425-437.
Ferrando C, Mellado-Artigas R, Gea A, et al. Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: A prospective, cohort, multicentre study. Rev Esp Anestesiol Reanim (Engl Ed). 2020;67(8):425-437.
Ferrando, C., Mellado-Artigas, R., Gea, A., Arruti, E., Aldecoa, C., Bordell, A., Adalia, R., Zattera, L., Ramasco, F., Monedero, P., Maseda, E., Martínez, A., Tamayo, G., Mercadal, J., Muñoz, G., Jacas, A., Ángeles, G., Castro, P., Hernández-Tejero, M., ... Hernández-Sanz, M. L. (2020). Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: A prospective, cohort, multicentre study. Revista Espanola De Anestesiologia Y Reanimacion, 67(8), 425-437. https://doi.org/10.1016/j.redar.2020.07.003
Ferrando C, et al. Patient Characteristics, Clinical Course and Factors Associated to ICU Mortality in Critically Ill Patients Infected With SARS-CoV-2 in Spain: a Prospective, Cohort, Multicentre Study. Rev Esp Anestesiol Reanim (Engl Ed). 2020;67(8):425-437. PubMed PMID: 32800622.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: A prospective, cohort, multicentre study. AU - Ferrando,C, AU - Mellado-Artigas,R, AU - Gea,A, AU - Arruti,E, AU - Aldecoa,C, AU - Bordell,A, AU - Adalia,R, AU - Zattera,L, AU - Ramasco,F, AU - Monedero,P, AU - Maseda,E, AU - Martínez,A, AU - Tamayo,G, AU - Mercadal,J, AU - Muñoz,G, AU - Jacas,A, AU - Ángeles,G, AU - Castro,P, AU - Hernández-Tejero,M, AU - Fernandez,J, AU - Gómez-Rojo,M, AU - Candela,Á, AU - Ripollés,J, AU - Nieto,A, AU - Bassas,E, AU - Deiros,C, AU - Margarit,A, AU - Redondo,F J, AU - Martín,A, AU - García,N, AU - Casas,P, AU - Morcillo,C, AU - Hernández-Sanz,M L, AU - ,, Y1 - 2020/07/13/ PY - 2020/8/18/pubmed PY - 2020/10/8/medline PY - 2020/8/18/entrez SP - 425 EP - 437 JF - Revista espanola de anestesiologia y reanimacion JO - Rev Esp Anestesiol Reanim (Engl Ed) VL - 67 IS - 8 N2 - BACKGROUND: The clinical course of COVID-19 critically ill patients, during their admission in the intensive care unit (UCI), including medical and infectious complications and support therapies, as well as their association with in-ICU mortality has not been fully reported. OBJECTIVE: This study aimed to describe clinical characteristics and clinical course of ICU COVID-19 patients, and to determine risk factors for ICU mortality of COVID-19 patients. METHODS: Prospective, multicentre, cohort study that enrolled critically ill COVID-19 patients admitted into 30 ICUs from Spain and Andorra. Consecutive patients from March 12th to May 26th, 2020 were enrolled if they had died or were discharged from ICU during the study period. Demographics, symptoms, vital signs, laboratory markers, supportive therapies, pharmacological treatments, medical and infectious complications were reported and compared between deceased and discharged patients. RESULTS: A total of 663 patients were included. Overall ICU mortality was 31% (203 patients). At ICU admission non-survivors were more hypoxemic [SpO2 with non-rebreather mask, 90 (IQR 83 to 93) vs. 91 (IQR 87 to 94); P<.001] and with higher sequential organ failure assessment score [SOFA, 7 (IQR 5 to 9) vs. 4 (IQR 3 to 7); P<.001]. Complications were more frequent in non-survivors: acute respiratory distress syndrome (ARDS) (95% vs. 89%; P=.009), acute kidney injury (AKI) (58% vs. 24%; P<10-16), shock (42% vs. 14%; P<10-13), and arrhythmias (24% vs. 11%; P<10-4). Respiratory super-infection, bloodstream infection and septic shock were higher in non-survivors (33% vs. 25%; P=.03, 33% vs. 23%; P=.01 and 15% vs. 3%, P=10-7), respectively. The multivariable regression model showed that age was associated with mortality, with every year increasing risk-of-death by 1% (95%CI: 1 to 10, P=.014). Each 5-point increase in APACHE II independently predicted mortality [OR: 1.508 (1.081, 2.104), P=.015]. Patients with AKI [OR: 2.468 (1.628, 3.741), P<10-4)], cardiac arrest [OR: 11.099 (3.389, 36.353), P=.0001], and septic shock [OR: 3.224 (1.486, 6.994), P=.002] had an increased risk-of-death. CONCLUSIONS: Older COVID-19 patients with higher APACHE II scores on admission, those who developed AKI grades ii or iii and/or septic shock during ICU stay had an increased risk-of-death. ICU mortality was 31%. SN - 2341-1929 UR - https://www.unboundmedicine.com/medline/citation/32800622/Patient_characteristics_clinical_course_and_factors_associated_to_ICU_mortality_in_critically_ill_patients_infected_with_SARS_CoV_2_in_Spain:_A_prospective_cohort_multicentre_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0034-9356(20)30187-0 DB - PRIME DP - Unbound Medicine ER -