Clinical Characteristics, Treatment, and Outcomes of Critically Ill Patients With COVID-19: A Scoping Review

Abstract

A growing number of studies on coronavirus disease 2019 (COVID-19) are becoming available, but a synthesis of available data focusing on the critically ill population has not been conducted. We performed a scoping review to synthesize clinical characteristics, treatment, and clinical outcomes among critically ill patients with COVID-19. Between 1/1/2020 and 5/15/2020, we identified high-quality clinical studies describing critically ill patients with a sample size >20 patients by performing daily searches of the World Health Organization and LitCovid databases on COVID-19. Two reviewers independently reviewed all abstracts (2785 unique articles), full-text (218 articles), and abstracted data (92 studies). 92 studies were included, including 61 from Asia, 16 from Europe, 10 from North and South America, as well as 5 multinational studies. Notable similarities among critically ill populations across all regions included a higher proportion of older males infected and with severe illness, high frequency of co-morbidities (hypertension, diabetes, and cardiovascular disease), abnormal chest imaging findings, and death secondary to respiratory failure. Differences in regions included newly identified complications (e.g., pulmonary embolism) and epidemiologic risk factors (e.g., obesity), less chest computed tomography imaging performed, and increased use of invasive mechanical ventilation (70-100% vs. 15-47% of ICU patients) in Europe and the US compared to Asia. Future research directions should include proof-of-mechanism studies to better understand organ injuries and large-scale collaborative clinical studies to evaluate the efficacy and safety of antivirals, antibiotics, IL-6 receptor blockers, and interferon. The current established predictive models require further verification in other regions outside China.

The COVID rehabilitation paradox: why we need to protect and develop geriatric rehabilitation services in the face of the pandemic

“…The majority of those with severe disease, requiring hospitalisation and intensive care, has been over 65 years of age and have pre-existing long-term conditions, disability and/or frailty [ 2–7 ]. Outside and in the context of COVID-19, there is good evidence that older people with frailty and multimorbidity who survive severe illnesses and intensive care are more likely than younger, fitter groups to experience complications including severe physical deconditioning, multi-organ failure, pulmonary dysfunction, cognitive decline, post-traumatic stress disorder and post-intensive care syndrome [ 8–11 ].…”

Scalable, Micro-Neutralization Assay for Qualitative Assessment of SARS-CoV-2 (COVID-19) Virus-Neutralizing Antibodies in Human Clinical Samples

“…In addition, convalescence in some people can be complicated by long-term sequelae that can be quite severe [2-4]. Early on, individuals with pre-existing comorbidities were identified as being more severely affected by SARS-CoV-2 infection [5, 6], and there are indications that age, gender, race, and other genetic factors play a role in disease severity and clinical outcome [7, 8].…”

Detection of serum KL-6 and SARS-CoV-2 antibody in patients with coronavirus disease 2019 and the diagnostic value in severe disease

“…Most moderately ill patients can recover after symptomatic and supportive treatment, while COVID-19 in severely ill/critically ill patients can be life-threatening due to a series of rapid pathophysiological changes such as body in ammatory response and "cytokine storm" [7][8][9]. Current diagnostic and therapeutic regimens emphasize early evaluation, and early treatment of severely ill/critically ill patients to help improve patient prognosis and reduce the risk of death [10][11][12][13]. We previously reported serum SARS-CoV-2 speci c Immunoglobulin A (IgA) is positively correlated with disease severity [14], and Krebs von den Lungen-6 (KL-6) is a good indicator for lung injury and in ammation in COVID-19 patients [15].…”