Clinical features and outcomes of critically ill patients with coronavirus disease 2019 (COVID-19): A multicenter cohort study

Abstract

Background Coronavirus disease-19 (COVID-19) manifested by a broad spectrum of symptoms, ranging from asymptomatic manifestations to severe illness and death. The purpose of the study was to extensively describe the clinical features and outcomes in critically ill patients with COVID19 in Saudi Arabia. Method A multi-center, non-interventional, cohort study for all critically ill patients aged 18 years or older who are admitted to intensive care units (ICUs) between March 1 st to August 31 st , 2020 with an objectively confirmed diagnosis of COVID19. The diagnosis of COVID19 was confirmed by Reverse Transcriptase–Polymerase Chain Reaction (RT-PCR) on nasopharyngeal and/or throat swabs. Multivariate logistic regression and generalized linear regression were used. We considered a P value of < 0.05 statistically significant. Results A total of 560 patients met the inclusion criteria. An extensive list of clinical features were associated with higher 30-days ICU mortality rate such as requiring mechanical ventilation (MV) or developing acute kidney injury within 24 hours of ICU admission, higher body temperature, white blood cells, blood glucose level, serum creatinine, fibrinogen, procalcitonin, creatine phosphokinase, aspartate aminotransferase and Total iron-binding capacity. The most common complication during ICU stay was respiratory failure that required MV (71.4%), followed by acute kidney injury (AKI) and thrombosis with a proportion of 46.8% and 11.4% respectively. Conclusion Among patients with COVID19 who were admitted to the ICU, several variables were associated with increasing the risk of ICU mortality at 30 days. Respiratory failure that required MV, AKI and thrombosis were the most common complications during ICU stay.

Ascorbic Acid as an Adjunctive Therapy in Critically Ill Patients with COVID-19: A Multicenter Propensity Score Matched Study

“…Of those included, 158 (21.3%) patients received ascorbic acid whereas 581(78.7%) patients did not. A total of 296 patients were included after propensity score matching using baseline severity scores (i.e., APACHE II, SOFA score, NUTRIC scores), systemic use of corticosteroids and study centers 31 .…”

“…By suppressing in ammatory response and oxidative stress, which are vital pathophysiological mechanisms of sepsis, ascorbic acid may have a bene cial effect against sepsis (19) . Moreover, patients with severe COVID-19 are known to have higher in ammatory markers and cytokine storm 31 .…”

“…Of interest, deep vein thrombosis (DVT) prophylaxis considered as a standard of care in our patients, and using DVT prophylaxis was similar between the two groups (pvalue: >0.999). Several published studies showed that the incidence of thrombosis was high in critically ill patients with COVID-19 (31,33) . Several pharmacological regimens have been proposed to impact the outcomes for patients with COVID-19 positively.…”

Early Versus Late Use of Dexamethasone in Critically Ill Patients With COVID-19: A Multicenter, Prospective Cohort Study

“…Baseline characteristics, baseline severity, and outcome variables were compared between the two groups. Multivariate logistic and generalized linear regression were used to nd out the relationship between the timing of initiation with different outcomes considered in this study after adjusting for the age, the needs for mechanical ventilation (MV) within 24 hours of ICU admission, and study centers 4 . The odds ratios (OR) and estimates with the 95% con dence intervals (CI) were reported for the associations.…”

“…1,2 The mortality rate reported is around 40% in critically ill patients with comorbidities who were infected with SARS-CoV-2. 3,4 Severe COVID-19 disease can enhance the systematic in ammatory response in critically ill patients, causing a systemic hyperin ammatory state, leading to multiple complications such as acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and thrombosis, which can increase mortality rate 4,5,6 . To date, no available treatment can work speci cally against the SARS-CoV-2 infection, and limited therapeutic options are showing a positive impact for reducing the complications secondary to COVID-19 infection.…”