Evaluation of factors which determining survival of SARS COV-2 infected patients in intensive care unit

Abstract

Background: The disease SARS-CoV-2, which started in Wuhan city of China and caused pandemic, created an increasing number of intensive care needs due to its severe respiratory failure. The factors that determine the course of patients followed in intensive care are different. Therefore, our aim was to determine the factors that predict mortality and affect prognosis by evaluating the patients admitted to our intensive care unit. Methods: This study is a single-center retrospective study involving 156 patients admitted to our Intensive Care Unit , who was diagnosed with SARS-COV-2 between 20 March and 8 June 2020. The data including characteristics, symptoms and laboratory findings of the patients were recorded and their relationships to mortality were evaluated Results: The mean age was 69 ± 15 years and 63% were male. The most common symptom was dyspnea (69.9%) and fever (60,9 %), respectively. Comorbidity was present in 82% and the most common comorbidity was HT and DM, respectively. All patients were admitted to the intensive care unit with (due to) hypoxemic respiratory failure. 106 patients (68.8%) were connected to mechanical ventilation, which was associated with mortality (p <0.0001). High flow oxygen therapy was delivered in 31 patients and was associated with survival (p <0.05). Tozulizumab, given in addition to the treatments increased the survival (p<0.05). Conclusion: We saw in our study that many parameters will be effective in predicting survival. As the most determining factors, not being intubated during admission and / or follow-up was observed to be effective on survival and was found to be associated with mortality.

Keywords

• SARS-COV-2
• mortality
• intubation
• intensive care unit

References

1. Grennan D. What is a pandemic? JAMA 2019; 321: 910. doi: 10.1001/jama.2019.0700.
2. World Health Organization. General’s opening remarks at the media briefing on COVID-19. Available at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at- themedia-briefing-on-covid-
3. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-COV-2[J]. Nat Microbiol 2020; 5: 536–44.
4. World Health Organization. WHO Director-General’s remarks at the media briefing on 2019-nCoV on 11 February 2020. Available at: https://www.who.int/dg/speeches/detail/whodirector-general-s- remarks-at-the-media-briefing-on
5. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report-51 https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10 (Accessed on 06 June, 2020)
6. Middle East Respiratory Syndrome Coronavirus. Available at: https://www.who.int/emergencies/mers-cov/en/. Accessed 06 June 2020
7. World Health Organization. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003.] Availablefromhttps://www.who.int/csr/sars/country/table2004_04_21/en/.
8. Johns Hopkins University the Center for Systems Science and Engineering (JHU-CSSE) Coronavirus Resource Center https://coronavirus.jhu.edu/data/mortality Accessed 06 June 2020.

9. The Republic of Turkey Ministry of Health General Directorate of Public Health. Accessed 24 JUNE 2020. Available from:https://hsgm.saglik.gov.tr/tr/covid19
10. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061-9. doi:10.1001/jama.2020.1585
11. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708-20. doi:10.1056/NEJMoa2002032
12. Norman G. Likert scales, levels of measurement and the "laws" of statistics. Adv Health Sci Educ Theory Pract 2010; 15: 625-32.
13. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323: 1239-42.
14. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020; 46: 846-8. Doi: 10.1007/s00134-020-05991-x
15. Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus disease 2019 case surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69: 759-65. doi:10.15585/mmwr.mm6924e2.
16. Auld S, Caridi-Scheible M, Blum JM, et al. ICU and ventilator mortality among critically ill adults with COVID-19. Preprint. medRxiv 2020; 2020.04.23.20076737. doi:10.1101/2020.04.23.20076737
17. Yu ST, Zhou Z, Cai Q, et al. Prognostic value of the C-reactive protein/albumin ratio in patients with laryngeal squamous cell carcinoma. Onco Targets Ther 2017; 10 :879-84.
18. Chai X, Hu L, Zhang Y, et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019‐nCoV infection. bioRxiv. 2020. doi.org/10.1101/2020.02.03.931766
19. Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol 2020; 5: 428-30.
20. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506.
21. Paliogiannis P, Zinellu A. Bilirubin levels in patients with mild and severe Covid-19: A pooled analysis. Liver Int 2020; 40: 1787-8. doi:10.1111/liv.14477.
22. Du RH, Liang LR, Yang CQ, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J 2020; 55: 2000524. doi:10.1183/13993003.00524-2020.
23. Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-COV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA 2020; 323: 1574-81.
24. Yang X, Yu Y, Xu J, et al. 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; S2213-2600(20)30079-5. doi:10.1016/S2213-2600(20)30079-5
25. Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med 2020; 180: 934-43. doi:10.1001/jamainternmed.2020.0994.
26. Myers LC, Parodi SM, Escobar GJ, Liu VX. Characteristics of hospitalized adults with COVID-19. JAMA 2020; 323: 2195-8.
27. Arentz M, Yim E, Klaff L, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA 2020; 323: 1612-4. doi:10.1001/jama.2020.4326
28. Carlino MV, Valenti N, Cesaro F, et al. Predictors of intensive care unit admission in patients with coronavirus disease 2019 (COVID-19). Monaldi Arch Chest Dis 2020; 90. doi:10.4081/monaldi.2020.1410
29. Bernd Sebastian Kamps, Christian Hofmann COVID reference. 2020; 4: 215.
30. Shimabukuro-Vornhagen A, Gödel P, Subklewe M, et al. Cytokine release syndrome. J Immunother Cancer 2018; 6: 56.
31. Teijaro JR. Cytokine storms in infectious diseases. Semin Immunopathol 2017; 39: 501-3. doi:10.1007/s00281-017-0640-2
32. Guaraldi G, Meschiari M, Cozzi-Lepri A, et al. Tocilizumab in patients with severe COVID-19: a retrospective cohort study. Lancet Rheumatol 2020; 2: 474-84. doi:10.1016/S2665-9913(20)30173-9.
33. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA 2020; 323: 2052-9. doi:10.1001/jama.2020.6775.