Analysis of clinical features and outcomes of 161 patients with severe and critical COVID‐19: A multicenter descriptive study

Abstract

Background This study aimed to investigate clinical characteristics, laboratory indexes, treatment regimens, and short‐term outcomes of severe and critical coronavirus disease 2019 (COVID‐19) patients. Methods One hundred and sixty one consecutive severe and critical COVID‐19 patients admitted in intensive care unit (ICU) were retrospectively reviewed in this multicenter study. Demographic features, medical histories, clinical symptoms, lung computerized tomography (CT) findings, and laboratory indexes on admission were collected. Post‐admission complications, treatment regimens, and clinical outcomes were also documented. Results The mean age was 59.38 ± 16.54 years, with 104 (64.60%) males and 57 (35.40%) females. Hypertension (44 [27.33%]) and diabetes were the most common medical histories. Fever (127 [78.88%]) and dry cough (111 [68.94%]) were the most common symptoms. Blood routine indexes, hepatic and renal function indexes, and inflammation indexes were commonly abnormal. Acute respiratory distress syndrome (ARDS) was the most common post‐admission complication (69 [42.86%]), followed by electrolyte disorders (48 [29.81%]), multiple organ dysfunction (MODS) (37 [22.98%]), and hypoproteinemia (36 [22.36%]). The most commonly used antiviral drug was lopinavir/ritonavir tablet. 50 (31.06%) patients died, while 78 (48.45%) patients healed and discharged, and the last 33 (20.50%) patients remained in hospital. Besides, the mean hospital stay of deaths was 21.66 ± 11.18 days, while the mean hospital stay of discharged patients was 18.42 ± 12.77 days. Furthermore, ARDS (P < .001) and MODS (P = .008) correlated with increased mortality rate. Conclusion Severe and critical COVID‐19 presents with high mortality rate, and occurrence of ARDS or MODS greatly increases its mortality risk.

Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis

“…The highest country-specific mortality from COVID-19 associated ARDS was found in China, which may be due to a lack of understanding of the origin and pathophysiology of the infection by SARS-CoV-2, as well as its management during the early outbreak of COVID-19. Of the 19 original Chinese studies included, all but two are originated in Hubei province (Wuhan is the capital city of Hubei province) [31][32][33][34][35][36][39][40][41][44][45][46][48][49][50]52,53], the epicenter of the COVID-19 outbreak. In fact, the study of Chen N et al [32] included a cluster of patients (49% of total patients included) who had a history of exposure to the Huanan seafood market, which is referred to as the 'ground zero' of the COVID-19.…”

“…Despite limited data was available, we managed to retrieve mortality data in COVID-19 patients with ARDS from six countries in addition to China and improved the reliability of the analysis presented in this article. Nevertheless, original studies that reported mortality in COVID-19 patients with ARDS with inadequate duration of follow-up [32,36,39,43,48,54,59,61,62] may have underestimated the mortality rate than if followed up until defintite outcome (death/discharged).…”

“…There was no study categorized as 'poor' (i.e., scored less than five points). The quality issue identified in the 'fair' studies [32,36,39,43,48,54,59,61,62] was the inadequate follow-up as these studies did not follow all patients from enrollment to discharge (or death) (Table S1). In addition, the comparability item was not assessed due to the absence of control or comparator.…”

“…31- 36,39-41,43-46,48-50,52-56,58-62], including 19 studies (76%)[31][32][33][34][35][36][39][40][41][43][44][45][46][48][49][50][52][53][54] from China, of which 16 studies (64%)[31][32][33][34][35][36][39][40][41][44][45][46]49,50,52,53] were conducted in the Wuhan city. The remaining 6 studies were from Italy (n = 3)[58][59][60], Germany (n = 1)[61], Poland (n = 1)[62], and Iran (n = 1)[56].…”

Clinical characteristics and factors affecting the duration of positive nucleic acid test for patients of COVID‐19 in XinYu, China

“…Comorbidities may exacerbate the patient's condition. Shi et al 7 reported that hypertension and diabetes were most common in severe and critical COVID‐19 patients. Chen et al 5 reported 50% of patients had underlying diseases including cardiovascular disease, diabetes, and gastrointestinal disease, and such patients were more likely to deteriorate or have poor prognoses.…”