Examining the Clinical Prognosis of Critically Ill Patients with COVID-19 Admitted to Intensive Care Units: A Nationwide Saudi Study

Abstract

Backgroundand Objectives: COVID-19 is a novel infectious disease caused by a single-stranded RNA coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to conduct a nationwide multicenter study to determine the characteristics and the clinical prognostic outcome of critically ill COVID-19 patients admitted to intensive care units (ICUs). Materials and Methods: This is a nationwide cohort retrospective study conducted in twenty Saudi hospitals. Results: An analysis of 1470 critically ill COVID-19 patients demonstrated that the majority of patients were male with a mean age of 55.9 ± 15.1 years. Most of our patients presented with a shortness of breath (SOB) (81.3%), followed by a fever (73.7%) and a cough (65.1%). Diabetes and hypertension were the most common comorbidities in the study (52.4% and 46.0%, respectively). Multiple complications were observed substantially more among non-survivors. The length and frequency of mechanical ventilation use were significantly greater (83%) in the non-survivors compared with the survivors (31%). The mean Sequential Organ Failure Assessment (SOFA) score was 6 ± 5. The overall mortality rate of the cohort associated with patients that had diabetes, hypertension and ischemic heart disease was 41.8%. Conclusion: Age; a pre-existing medical history of hypertension, diabetes and ischemic heart disease; smoking cigarettes; a BMI ≥ 29; a long mechanical ventilation and ICU stay; the need of ventilatory support; a high SOFA score; fungal co-infections and extracorporeal membrane oxygenation (ECMO) use were key clinical characteristics that predicted a high mortality in our population.

Characteristics of mechanically ventilated COVID-19 patients in the Al-Ahsa Region of Saudi Arabia: a retrospective study with survival analysis

“…In line with our findings, the mortality rate among the recipients of mechanical ventilation was high at 82.7%. 15 A large study by Alhumaid et al 30 reported clinical features and prognostic factors of 1014 COVID-19 patients from six hospitals in Al-Ahsa between 1 March 2020 and 30 July 2020, a 2-month overlap with our study and found the same common comorbidities as in our study. However, Alhumaid et al did not report mortality rates among patients on mechanical ventilation.…”

“… 14 Several nationwide studies from Saudi Arabia have identified common comorbidities in intensive care patients (hypertension, diabetes, ischemic heart disease). 15 , 16 …”

Early use of tocilizumab in solid organ transplant recipients with COVID‐19: A retrospective cohort study in Saudi Arabia

“…14 Several retrospective case-control studies and randomized trials evaluated the role of tocilizumab in reducing the mortality of severe COVID-19 and had conflicting results. [7][8][9][10][11][15][16][17][18][19][20] However, SOT recipients were not included in these studies except for one study, which only included nine cases (6%). 21 The largest cohort of COVID 19 transplant patients who received IL-6 blockers included 80 cases in Spain.…”

“…3 The same pattern of COVID-19 severity was reported in Saudi Arabia with various clinical presentations including mild, moderate, and critical cases; in addition to asymptomatic cases. [4][5][6][7][8] Previous studies showed that COVID-19 disease is associated with an increase in plasma concentrations of cytokines and inflammatory markers including elevation of ferritin, lactate dehydrogenase (LDH), D-dimer, and C-reactive protein (CRP). [9][10][11] Additionally, lung tissue histopathology examination of COVID-19 deceased patients showed inflammatory cellular infiltration, proteinaceous exudate, and evidence of extensive alveolar edema.…”

Outcome of COVID19 in Patients With Osteogenesis Imperfecta: A Retrospective Multicenter Study in Saudi Arabia

“…As the COVID-19 pandemic continues to cause new cases worldwide, the epidemiology of SARS-CoV-2 infection is evolving with the emergence of variant strains of concern, in addition to the reporting of an increasing number of cases among children ( 1 , 2 ). Both adults and children with comorbidities infected with COVID-19 are at risk to develop severe pneumonia requiring hospitalization ( 3 , 4 ). Although they are rare, children with genetic diseases infected with SAS-CoV-2 infection were more likely to be hospitalized and develop severe illness and intensive care unit admission ( 5 ).…”