Clinical characteristics and outcomes of critically ill COVID-19 patients in Tokyo: a single-center observational study from the first wave

Abstract

Background Many studies have been published about critically ill coronavirus disease 2019 (COVID-19) during the early phases of the pandemic but the characteristic or survival of critically ill Japanese patients have not yet been investigated. We sought to investigate the characteristics, inflammatory laboratory finding trends, and outcomes among critically ill Japanese patients who were admitted to the intensive care unit (ICU) with the first wave of COVID-19. Methods A retrospective observational study was performed in a single institution in the center of Tokyo. Laboratory-confirmed COVID-19 patients admitted to the ICU from March 19 to April 30, 2020 were included. Trends for significant inflammatory laboratory findings were analyzed. In-hospital death, days of mechanical ventilation or oxygen supplementation, days of ICU or hospital stay were followed until May 26, 2020. Results Twenty-four patients were included. Median age was 57.5 years, and 79% were male. The neutrophil-to-lymphocyte ratio was elevated to a median of 10.1 on admission and peaked on Day 10 of illness. Seventeen patients were intubated on Day 11 of illness and received mechanical ventilation. One patient underwent extracorporeal membrane oxygenation. The majority (88%) received systemic steroids, including 16 patients who received high dose methylprednisolone (500–1000 mg). Favipiravir was used in 38% of patients. Two patients, including 1 who refused intensive care, died. Eighteen patients were discharged. Median length of ICU and hospital stay for all patients was 6 and 22 days, respectively. Median length of ventilator dependency was 7 days. Four patients underwent a tracheostomy and received prolonged ventilation for more than 21 days. One patient receiving mechanical ventilation died. All survivors discontinued ventilator use. Conclusions Mortality was remarkably low in our single institutional study. Three survivors received mechanical ventilation for more than 3 weeks. Trends of clinically significant laboratory markers reflected the clinical course of COVID-19.

Characteristics of COVID-19 in multicenter ICUs in Japan

“…Several studies have evaluated multicenter epidemiology and outcomes for patients with COVID-19 in intensive care units (ICUs), with reported mortality ranging widely-from 31 to 58% (references S1-S8 in Online Resources 2). In Japan, only one single-center study has described the epidemiology of COVID-19 patients in the ICU [1], and no multicenter studies have been conducted. Therefore, this study aimed to describe the characteristics and outcomes of patients with COVID-19 who were admitted to multicenter ICUs in Japan.…”

Clinical Features and Outcome of Low and High Corticosteroids in Admitted COVID-19 Patients

“…The patients in the high-dose steroid had a higher rate of the use of favipiravir than those in the low-dose steroid. The use of favipiravir was 38% in a study from Tokyo, Japan [ 21 ]. In a recent randomized controlled trial, the use of favipiravir was associated with shorter duration of illness in those with mild-moderate COVID-19 [ 22 ].…”

“…In a recent randomized controlled trial, the use of favipiravir was associated with shorter duration of illness in those with mild-moderate COVID-19 [ 22 ]. The mean days of ICU and hospital stay was 6 and 22 days in a study from Tokyo [ 21 ]. However, the mean (±SD) of ICU and hospital stay were 10.30 (±17.56) and 18 (5 ± 8.1) for low-dose steroid and were 12 (38.7) and 5.95 (6.26) for high-dose steroid, respectively.…”

“…The use of high-dose corticosteroid is not well studied in relation to COVID-19 cases. In a study from Tokyo, Japan, 16 (66.7%) of 24 patients received high-dose methylprednisolone (500–1000 mg) [ 21 ]. In a report of two cases, there was a suggestion that high-dose steroid might be of benefit in low resource countries [ 23 ].…”

One-Year Outcomes of Postintensive Care Syndrome in Critically Ill Coronavirus Disease 2019 Patients: A Single Institutional Study

“…The inclusion criteria included ICU admission for acute respiratory distress and laboratory or radiological confirmation of COVID-19 ( 11 ). Patients who died during hospitalization were excluded.…”