Background: In Kuwait, prior to the first case of COVID-19 being reported in the country, mass screening of incoming travelers from countries with known outbreaks was performed and resulted in the first identified cases in the country. All COVID-19 cases at the time and subsequently after, were transferred to a single center, Jaber Al-Ahmad Al-Sabah Hospital, where the patients received standardized investigations and treatments. The objective of this study was to characterize the demographics, clinical manifestations, and outcomes in this unique patient population. Methods: This retrospective cohort study was conducted between 24th February 2020 and 20th April 2020. All consecutive patients in the entire State of Kuwait diagnosed with COVID-19 according to WHO guidelines and admitted to Jaber Al-Ahmad Al-Sabah Hospital were included. Patients received standardized investigations and treatments. Multivariable analysis was used to determine the associations between risk factors and outcomes (admission to intensive care and/or mortality). Findings: Of 1096 patients, the median age was 41 years and 81% of patients were male. Most patients were asymptomatic on admission (46.3%), of whom 35 later developed symptoms, and 59.7% had no signs of infection. Only 3.6% of patients required an ICU admission and 1.7% were dead at the study's cutoff date. On multivariable analysis, the risk factors found to be significantly associated with admission to intensive care were age above 50 years old, a qSOFA score above 0, smoking, elevated CRP and elevated procalcitonin levels. Asthma, smoking and elevated procalcitonin levels correlated significantly with mortality in our cohort.
Summary The coronavirus disease 2019 (COVID‐19) pandemic is straining the healthcare system, particularly for patients with severe outcomes requiring admittance to the intensive care unit (ICU). This study investigated the potential associations of obesity and diabetes with COVID‐19 severe outcomes, assessed as ICU admittance. Medical history, demographic and patient characteristics of a retrospective cohort (1158 patients) hospitalized with COVID‐19 were analysed at a single centre in Kuwait. Univariate and multivariate analyses were performed to explore the associations between different variables and ICU admittance. Of 1158 hospitalized patients, 271 had diabetes, 236 had hypertension and 104 required admittance into the ICU. From patients with available measurements, 157 had body mass index (BMI) ≥25 kg/m2. Univariate analysis showed that overweight, obesity class I and morbid obesity were associated with ICU admittance. Patients with diabetes were more likely to be admitted to the ICU. Two models for multivariate regression analysis assessed either BMI or diabetes on ICU outcomes. In the BMI model, class I and morbid obesities were associated with ICU admittance. In the diabetes model, diabetes was associated with increased ICU admittance, whereas hypertension had a protective effect on ICU admittance. In our cohort, overweight, obesity and diabetes in patients with COVID‐19 were associated with ICU admittance, increasing the risk of poor outcomes.
Background: The Coronavirus disease 2019 (COVID19) pandemic is straining the healthcare system, particularly for patients with severe outcomes who require admittance to the intensive care unit (ICU). This study aimed to investigate the potential associations of obesity and diabetes with COVID19 severe outcomes, assessed as ICU admittance. Subjects: Demographic and patient characteristics from a retrospective cohort of 1158 patients hospitalized with COVID19 in a single center in Kuwait, along with their medical history, were analyzed. Univariate and multivariate analyses were performed to explore the associations between different variables and ICU admittance. Results: From the 1158 hospitalized patients, 271 (23.4%) had diabetes, 236 (20.4%) had hypertension and 104 (9%) required admittance into the ICU. From patients with available measurements, 157 (21.6%) had body mass index (BMI)≥25 kg/m2. Univariate analysis showed that overweight (BMI=25.0~29.9 kg/m2), obesity class I (BMI=30~34.9 kg/m2) and morbid obesity (BMI≥40 kg/m2) associated with ICU admittance (odds ratio (OR) [95% confidence intervals (CI)]: 2.45 [1.26~4.74] p value=0.008; OR [95% CI]: 3.51 [1.60~7.69] p value=0.002; and OR [95% CI]: 5.18 [1.50~17.85] p value=0.009], respectively). Patients with diabetes were more likely to be admitted to ICU (OR [95% CI]: 9.38 [5.49~16.02]). Two models for multivariate regression analysis were used, assessing either BMI or diabetes on ICU outcomes. In the BMI model, class I obesity and morbid obesity were associated with ICU admittance (adjusted OR (AOR) [95% CI]: 2.7 [1.17~6.20] p value=0.019 and AOR [95% CI]: 3.95 [1.00~15.20] p value=0.046, respectively). In the diabetes model, diabetes was associated with higher ICU admittance (AOR [95% CI]: 5.49 [3.13~9.65] p value<0.001) whereas hypertension had a protective effect on ICU admittance (AOR [95% CI]: 0.51 (0.28−0.91). Conclusions: In our cohort, overweight, obesity and diabetes in patients with COVID19 were associated with ICU admittance, putting these patients at higher risk of poor outcomes.
Background: The development of barotrauma has been suggested to complicate the management of mechanically ventilated COVID-19 patients admitted to the intensive care unit (ICU). This study aims to identify potential risk factors associated with the development of barotrauma related complications in COVID-19 patients receiving mechanical ventilation. Methods: A retrospective cohort study was carried out in a single COVID-19 designated center in Kuwait. Three hundred and forty-three confirmed COVID-19 patients transferred and/or admitted to our institution between February 26, 2020 and June 20, 2020 were included in the study. All patients were admitted into the ICU with the majority being mechanically ventilated (81.3%). Results: Fifty-four (15.4%) patients developed barotrauma, of which 49 (90.7%) presented with pneumothorax, and 14.8% and 3.7% due to pneumomediastinum and pneumopericardium respectively. Of those that developed barotrauma, 52 (96.3%) patients were in acute respiratory distress syndrome (ARDS). Biochemically, the white blood cells (p = 0.001), neutrophil percentage (p = 0.012), lymphocyte percentage (p = 0.014), neutrophil: lymphocyte ratio (NLR) (p=<0.001) and lactate dehydrogenase (LDH) (p = 0.002) were found to be significantly different in patients that developed barotrauma. Intubation due to low level of consciousness (p = 0.007), a high admission COVID-GRAM score (p = 0.042), and a positive-end expiratory pressure (PEEP) higher than the control group (p = 0.016) were identified as potential risk factors for the development of barotrauma. Conclusion: Patients infected with COVID-19 have a significant risk of developing barotrauma when receiving invasive mechanical ventilation. This poses a substantial impact on the hospital course of the patients and clinical outcome, correlating to a higher mortality rate in this cohort of patients.
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