Epidemiology, outcomes, and the use of intensive care unit resources of critically ill patients diagnosed with COVID-19 in Sao Paulo, Brazil: A cohort study

Abstract

Background The coronavirus disease (COVID-19) pandemic has brought significant challenges worldwide, with high mortality, increased use of hospital resources, and the collapse of healthcare systems. We aimed to describe the clinical outcomes of critically ill COVID-19 patients and assess the impact on the use of hospital resources and compare with critically ill medical patients without COVID-19. Methods and findings In this retrospective cohort study, we included patients diagnosed with COVID-19 admitted to a private ICU in Sao Paulo, Brazil from March to June 2020. We compared these patients with those admitted to the unit in the same period of the previous year. A total of 212 consecutive patients with a confirmed diagnosis of COVID-19 were compared with 185 medical patients from the previous year. Patients with COVID-19 were more frequently males (76% vs. 56%, p<0.001) and morbidly obese (7.5% vs. 2.2%, p = 0.027), and had lower SAPS 3 (49.65 (12.19) vs. 55.63 (11.94), p<0.001) and SOFA scores (3.78 (3.53) vs. 4.48 (3.11), p = 0.039). COVID-19 patients had a longer ICU stay (median of 7 vs. 3 days, p<0.001), longer duration of mechanical ventilation (median of 9 vs. 4 days, p = 0.003), and more frequent tracheostomies (10.8 vs. 1.1%, p<0.001). Survival rates until 28 days were not statistically different (91% vs. 85.4%, p = 0.111). After multivariable adjustment for age, gender, SAPS 3, and Charlson Comorbidity Index, COVID-19 remained not associated with survival at 28 days (HR 0.59, 95% CI 0.33–1.06, p = 0.076). Among patients who underwent invasive mechanical ventilation, the observed mortality at 28-days was 16.2% in COVID-19 patients compared to 34.6% in the previous year. Conclusions COVID-19 required more hospital resources, including invasive and non-invasive ventilation, had a longer duration of mechanical ventilation, and a more prolonged ICU and hospital length of stay. There was no difference in all-cause mortality at 28 and 60 days, suggesting that health systems preparedness be an important determinant of clinical outcomes.

Risk factors for mortality of adult patients with COVID-19 hospitalised in an emerging country: a cohort study

“…Two studies with smaller numbers of patients exclusively admitted to ICU reported a mortality of 52% in Mexico 15 and 15% in Brazil. 16 Our results indicate that, considering hospitalised patients both from the ICU and the ward, mortality in our setting may be higher than the reported in other parts of the world (12%-28%). [17][18][19][20][21] Possible reasons for the high mortality rate in this population may include differences in thresholds for hospitalisation in our country; however, the presence of high-risk factors may also be involved and is noteworthy to mention.…”

Association Between SARS-CoV-2 Infection and Immune-Mediated Myopathy in Patients Who Have Died

“…58 With the heterogeneous course of COVID-19, with sometimes long stays in intensive care and often septic states, appropriate control groups are mandatory. 59 Our control group was comparable with the COVID-19 cohort with regard to invasive treatments, clinical and laboratory indicators of sepsis, and general systemic inflammation. Length of hospitalization and intensive care unit stays were longer in the cohort with COVID-19, as seen elsewhere.…”

Predicting Severe/Critical Outcomes in Patients With SARS-CoV2 Pneumonia: Development of the prediCtion seveRe/crItical ouTcome in COVID-19 (CRITIC) Model

“…Patients with severe cardiovascular injury and underlying cardiac insufficiency, for example, are more likely to experience adverse events, according to recent reports ( 16 , 36 ). For clinical prognosis, summary comorbidity scales such as the CCI are widely used ( 37 , 38 ). The CCI was created to predict the probability of death within 1 year of being admitted to the hospital.…”