A single-centered, retrospective cohort study of critically ill COVID-19 patients: Is the heart at risk?

Abstract

The Philippines has the highest COVID-19 mortality rate by country (per million) in South East Asia. We aim to explore predictors of mortality among critically ill COVID-19 patients. METHODSThis single-centered, retrospective cohort study included consecutive patients with confirmed COVID-19 infection and acute respiratory distress syndrome requiring mechanical ventilation and intensive care unit (ICU) admission at The Medical City hospital from March 6 to March 31, 2020. Clinical data were obtained from medical records review and compared between survivors and non-survivors. RESULTSAmong 30 patients (mean age 65±3 years, interquartile range 32-86; 63% male), hypertension (67%), diabetes mellitus (45%), hyperlipidemia (40%) and smoking history (30%) were common. Those with echocardiogram showed no left ventricular dysfunction except 1 (preexisting heart failure), despite elevated troponin and NT-pro BNP. All had sepsis; 87% had septic shock. Twenty two (73%) died, 6 (20%) discharged improved, 1 (3%) transferred to another hospital (outcome unknown), and 1 (3%) still admitted. Mean duration from ICU admission to death was 13 days for non-survivors. Use of norepinephrine plus vasopressin and unfractionated heparin (UFH) for thromboprophylaxis were significantly higher among non-survivors versus survivors. There was a nonsignificant trend towards a higher mean troponin and NT-proBNP among non-survivors versus survivors. CONCLUSIONWe report that use of norepinephrine plus vasopressin and UFH for thromboprophylaxis were predictors of mortality among critically ill COVID-19 patients. Mean survival time of non-survivors is likely to be 13 days after ICU admission. Elevated troponin and NT-proBNP were not associated with increased mortality.