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