Clinical Course and Outcomes of Severe Covid-19: A National Scale Study
Abstract
:1. Introduction
2. Methods
2.1. Critical Illness-Defining Conditions
2.2. Data Collection
2.3. Statistical Analysis
3. Results
4. Discussion
5. Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variable (No.) | Total (n = 156) | Discharged Alive (n = 69) | Died (n = 87) | p Value |
---|---|---|---|---|
Age, Median (IQR) | 72 (60–82) | 61 (49–69) | 80 (72–87) | <0.001 |
Sex | 0.003 | |||
Female (%) | 48 (31) | 13 (19) | 35 (40) | |
Male (%) | 108 (69) | 56 (81) | 52 (60) | |
Comorbidities | ||||
Cancer | ||||
Active | 8 (5.1) | 3 | 5 | 0.6 |
History | 14 (9) | 2 | 12 | 0.02 |
Cardiovascular Disease | ||||
Hypertension | 85 (54.5) | 23 | 62 | <0.00001 |
Coronary Artery Disease | 33 (21.2) | 9 | 24 | 0.03 |
Congestive Heart Failure | 17 (10.9) | 3 | 14 | 0.02 |
Arrhythmia | 17 (10.9) | 3 | 14 | 0.02 |
Chronic Respiratory Disease | ||||
Chronic Obstructive Pulmonary Disease | 13 (8.3) | 3 | 10 | 0.1 |
Immunosuppression a | 6 (3.8) | 2 | 4 | 0.5 |
Kidney Disease b | 24 (15.4) | 4 | 20 | 0.003 |
Liver Disease | 2 (1.3) | 1 | 1 | 0.8 |
Obesity | 109 (69.9) | |||
Obesity (BMI < 25) | 27 (24.8) | 6 | 21 | 0.01 |
Obesity (BMI 25–30) | 50 (45.9) | 29 | 21 | 0.01 |
Morbid Obesity | 32 (29.4) | 18 | 14 | 0.1 |
Metabolic Disease | ||||
Diabetes c | 62 (39.7) | 20 | 42 | 0.01 |
Dyslipidemia | 24 (15.4) | 16 | 8 | 0.02 |
Hypothyroidism | 15 (9.6) | 6 | 9 | 0.7 |
Smoker | ||||
Never | 143 (91.6) | 61 | 81 | 0.3 |
Stopped Over a Year Prior Hospitalization | 11 (7.1) | 6 | 5 | 0.5 |
Active | 2 (1.3) | 1 | 1 | 0.8 |
Dementia | 21 | 0 | 21 | <0.00001 |
Comorbidities | ||||
None | 30 | 24 | 6 | <0.00001 |
1 | 27 | 18 | 9 | 0.01 |
2 | 30 | 11 | 19 | 0.3 |
3 | 30 | 8 | 22 | 0.03 |
>3 | 39 | 8 | 31 | 0.0006 |
Critically Ill Defining Condition * | ||||
Acute Respiratory Distress Syndrome (%) | 69 (44) | 34 (49) | 35 (40) | 0.258 |
Acute Organ Failure (%) | 103 (66) | 42 (61) | 61 (70) | 0.226 |
Sepsis (%) | 40 (26) | 9 (13) | 31 (36) | 0.001 |
Length of ICU stay (days), median (IQR) | 10 (5–17) | 15 (9–21) | 7 (3–12) | <0.001 |
Vital Measurements (No. of Patients) | Value | Discharged Alive | Died | p Value |
---|---|---|---|---|
Total no. | 156 | 69 | 87 | |
Temperature, °C (127) | 59 | 68 | ||
Median (IQR) | 37.6 (37–38.4) | 37.8 (37.2–38.4) | 37.5 (37–38.3) | 0.315 |
>38 °C | 42 (33) | 23 | 19 | 0.187 |
Oxygen Saturation (142) | 67 | 75 | ||
Median (IQR) | 92 (87–95) | 93 (88–95) | 92 (85–95) | 0.04 |
<90 | 53 (37.3) | 22 | 31 | 0.296 |
Received Supplemental Oxygen (128) | 58 | 70 | 0.561 | |
Respiratory Rate (47) | 23 | 24 | ||
Median (IQR) | 22 (16–30) | 24 (18–32) | 19 (12–29) | 0.077 |
>20 | 25 (53.2) | 14 | 11 | 0.302 |
Heart Rate, beats/min (139) | 66 | 73 | ||
Median (IQR) | 91 (80–101) | 91 (80–100) | 91 (81–104) | 0.331 |
<60 | 5 (3.6) | 2 | 3 | 0.733 |
>100 | 36 (25.9) | 15 | 21 | 0.804 |
Systolic Blood Pressure (139) | 67 | 72 | ||
Median (IQR) | 135 (116–150) | 132 (120–150) | 136 (114–148) | 0.791 |
Diastolic Blood Pressure (138) | 66 | 72 | ||
Median (IQR) | 73 (60–82) | 74 (65–83) | 70 (60–82) | 0.489 |
Chest X-ray (156) | 69 | 87 | ||
Normal (13) | 4 | 9 | 0.302 | |
Unilateral Filtration (21) | 7 | 14 | 0.280 | |
Bilateral Filtration (117) | 57 | 60 | 0.051 | |
Pleural Effusion (5) | 1 | 4 | 0.268 | |
Initial laboratory measures, median (no.) | ||||
White Blood Cell Count, × 109/L (149) | 68 | 81 | ||
Median (IQR) | 8.29 (6–11.3) | 7.75 (6–10.34) | 8.6 (6–13) | 0.048 |
<3.8 × 109/L | 11 | 6 | 5 | 0.538 |
>10.8 × 109/L | 41 (27.5) | 14 | 27 | 0.083 |
Creatinine mg/dl (149) | 68 | 81 | ||
Median (IQR) | 1 (0.8–1.4) | 0.86 (0.66–1.06) | 1.19 (0.8–1.67) | 0.076 |
Aspartate aminotransferase, U/L (123) | 62 | 61 | ||
Median (IQR) | 48 (30–75) | 44 (28–72) | 55 (31–88) | 0.148 |
>40 U/L | 71 (57.7) | 34 | 37 | 0.514 |
Alanine aminotransferase, U/L (130) | 65 | 65 | ||
Median (IQR) | 30 (19–54) | 30 (21–62) | 27 (18–52) | 0.683 |
>60 U/L | 26 (20) | 17 | 9 | 0.079 |
C-Reactive Protein, mg/dL (141) | 68 | 73 | ||
Median (IQR) | 20.16 (16–40.15) | 23.7 (12–49.59) | 0.959 | |
D-dimer, ng/mL (80) | ||||
Median (IQR) | 1445 (887–2780) | 1225 (780–2042) | 1719 (1087–3622) | 0.546 |
No. (%) | Discharged Alive | Died | p Value | |
---|---|---|---|---|
Total no. | 156 | 69 | 87 | |
Interventions | ||||
Oxygen | 128 | 58 | 70 | 0.6 |
CPAP/BiPAP | 39 | 29 | 10 | <0.0001 |
Invasive Mechanical Ventilation | 93 | 41 | 52 | 0.9 |
TPN | 15 | 9 | 6 | 0.2 |
Enteral Nutrition | 74 | 29 | 45 | 0.2 |
ECMO | 6 | 5 | 1 | <0.05 |
Renal Replacement Therapy | 14 | 2 | 12 | 0.02 |
Tracheostomy | 14 | 12 | 2 | 0.001 |
Medical Therapy | ||||
Antibiotic Therapy | 131 | 62 | 69 | 0.07 |
Anti-IL-6 | 9 | 6 | 3 | 0.15 |
Anti-Fibrinolytic Therapy | 4 | 2 | 2 | 0.8 |
Glucocorticoid Therapy | 34 | 20 | 14 | |
Inotropic Therapy | 78 | 31 | 47 | 0.3 |
IVIG | 7 | 5 | 2 | 0.1 |
Anti-Inflammatory | 18 | 10 | 8 | 0.474 |
Antiviral Therapy | 31 | 23 | 8 | <0.001 |
Antimalarial Therapy | 124 | 63 | 61 | 0.001 |
Complications | ||||
Respiratory Failure | 109 | 42 | 67 | 0.029 |
ARDS | 59 | 25 | 34 | 0.716 |
Heart Failure | 11 | 2 | 9 | 0.071 |
Sepsis | 21 | 3 | 18 | 0.003 |
Septic Shock | 29 | 9 | 20 | 0.113 |
Coagulopathy | 4 | 3 | 1 | 0.209 |
Acute Cardiac Injury | 8 | 3 | 5 | 0.694 |
Acute Kidney Injury | 40 | 7 | 33 | <0.0001 |
Secondary Infection | 27 | 10 | 17 | 0.408 |
Variable | Univariable Analysis | Multivariable Analysis | ||||
---|---|---|---|---|---|---|
OR | 95% CI | p Value | OR | 95% CI | p Value | |
Age, per year | 1.11 | 1.07–1.15 | <0.0001 | 1.08 | 1.03-1.13 | 0.0004 |
Sex | 0.0048 | 0.183 | ||||
Male | Reference | Reference | ||||
Female | 2.89 | 1.38–6.07 | 2.23 | 0.68–7.28 | ||
HTN | <0.0001 | 0.532 | ||||
Absent | Reference | Reference | ||||
Present | 4.96 | 250–9.81 | 1.45 | 0.45-4.66 | ||
Diabetes | 0.015 | 0.464 | ||||
Absent | Reference | Reference | ||||
Present | 2.28 | 1.17–4.4 | 1.51 | 0.49–460 | ||
IHD | 0.030 | 0.614 | ||||
Absent | Reference | Reference | ||||
Present | 2.53 | 1.09-5.90 | 1.36 | 0.40–4.57 | ||
COPD | 0.122 | |||||
Absent | Reference | |||||
Present | 2.85 | 0.75–10.81 | ||||
ARDS | 0.259 | |||||
Absent | Reference | |||||
Present | 1.44 | 0.36–1.31 | ||||
Acute Organ Failure | 0.227 | |||||
Absent | Reference | |||||
Present | 1.50 | 0.77-2.93 | ||||
Sepsis | 0.002 | 0.013 | ||||
Absent | Reference | Reference | ||||
Present | 3.69 | 1.61–8.43 | 4.97 | 1.40–17.69 | ||
CRP (mg/dL), Per Unit | 1.00 | 0.99–1.00 | 0.1985 | |||
WBC (109/L), Per Unit | 1.07 | 0.99–1.15 | 0.033 | 1.05 | 0.93–1.17 | 0.392 |
Ventilation | 0.596 | |||||
Absent | Reference | |||||
Present | 1.19 | 0.61–2.32 | ||||
Anti-Inflammatory * | 0.074 | |||||
Not Administered | Reference | |||||
Administered | 0.52 | 0.25–1.06 | ||||
Antimalarial * | 0.002 | 0.085 | ||||
Not Administered | Reference | Reference | ||||
Administered | 0.22 | 0.08–0.58 | 0.30 | 0.08–1.17 | ||
Antiviral * | 0.0007 | 0.065 | ||||
Not administered | Reference | Reference | ||||
Administered | 0.21 | 0.08–0.52 | 0.19 | 0.035–1.11 | ||
Length of ICU Stay (days) | 0.89 | 0.85–0.93 | <0.001 | 0.92 | 0.84–0.96 | 0.0012 |
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Amit, M.; Sorkin, A.; Chen, J.; Cohen, B.; Karol, D.; Tsur, A.M.; Lev, S.; Rozenblat, T.; Dvir, A.; Landau, G.; et al. Clinical Course and Outcomes of Severe Covid-19: A National Scale Study. J. Clin. Med. 2020, 9, 2282. https://doi.org/10.3390/jcm9072282
Amit M, Sorkin A, Chen J, Cohen B, Karol D, Tsur AM, Lev S, Rozenblat T, Dvir A, Landau G, et al. Clinical Course and Outcomes of Severe Covid-19: A National Scale Study. Journal of Clinical Medicine. 2020; 9(7):2282. https://doi.org/10.3390/jcm9072282
Chicago/Turabian StyleAmit, Moran, Alex Sorkin, Jacob Chen, Barak Cohen, Dana Karol, Avishai M Tsur, Shaul Lev, Tal Rozenblat, Ayana Dvir, Geva Landau, and et al. 2020. "Clinical Course and Outcomes of Severe Covid-19: A National Scale Study" Journal of Clinical Medicine 9, no. 7: 2282. https://doi.org/10.3390/jcm9072282
APA StyleAmit, M., Sorkin, A., Chen, J., Cohen, B., Karol, D., Tsur, A. M., Lev, S., Rozenblat, T., Dvir, A., Landau, G., Fridrich, L., Glassberg, E., Kesari, S., Sviri, S., Gelman, R., Miller, A., Epstein, D., Ben-Avi, R., Matan, M., ... Benov, A. (2020). Clinical Course and Outcomes of Severe Covid-19: A National Scale Study. Journal of Clinical Medicine, 9(7), 2282. https://doi.org/10.3390/jcm9072282