Factors associated with admission to intensive care units in COVID-19 patients in Lyon-France

Abstract

Introduction A new respiratory virus, SARS-CoV-2, has emerged and spread worldwide since late 2019. This study aims at analysing clinical presentation on admission and the determinants associated with admission in intensive care units (ICUs) in hospitalized COVID-19 patients. Patients and methods In this prospective hospital-based study, socio-demographic, clinical and biological characteristics, on admission, of adult COVID-19 hospitalized patients presenting from the community for their first admission were prospectively collected and analysed. Characteristics of patients hospitalized in medical ward to those admitted in ICU were compared using Mann-Whitney and Chi-square or Fisher exact test when appropriate. Univariate logistic regression was first used to identify variables on admission that were associated with the outcome i.e. admission to an ICU versus total hospital stay in a medical ward. Forward selection was then applied beginning with sex, age and temperature in the multivariable logistic regression model. Results Of the 412 patients included, 325 were discharged and 87 died in hospital. Multivariable regression showed increasing odds of ICU hospitalization with temperature (OR, 1.56 [95% CI, 1.06–2.28] per degree Celsius increase), oxygen saturation <90% (OR, 12.45 [95% CI, 5.27–29.4]), abnormal lung auscultation on admission (OR, 3.58 [95% CI, 1.58–8.11]), elevated level of CRP (OR, 2.7 [95% CI, 1.29–5.66for CRP>100mg/L vs CRP<10mg/L). and monocytopenia (OR, 3.28 [95% CI, 1.4–7.68]) were also associated with increasing odds of ICU hospitalization. Older patients were less likely to be hospitalized in ICU (OR, 0.17 [95%CI, 0.05–0.51]. Conclusions Age and delay between onset of symptoms and hospital admission were associated with the risk of hospitalisation in ICU. Age being a fixed variable, interventions that shorten this delay would improve the prognosis of Covid-19 patients.

Factors associated with admission to the intensive care unit and mortality in patients with COVID-19, Colombia

“…The median age of patients with COVID-19 was similar to that found in other studies (56.0-72.0 years) [11][12][13][14][15][16][17], with a predominance of males, as also identified in most studies (51.9-62.0%) [11][12][13][15][16][17][18], except in a cohort of patients in the USA where a higher proportion of females (55.9%) was described [14]. Regarding these sociodemographic variables, some studies have found that males have a higher risk of complications [14,19,20] and death [14,18,20]; those findings were not identified in this report, but our results are consistent with those described in other studies [15,21,22]. It was observed that as age increased, patients had a higher probability of dying, consistent with a large number of international publications [14,17,[21][22][23][24] and local studies [11,25], probably due to a higher disease burden [10].…”

“…The clinical manifestations most described in the literature have been cough, fever and dyspnea [11,14,15,17,22,23], as found in this analysis. With respect to the NEWS 2 score, which involves different clinical parameters, this report showed that a higher score was associated with a greater probability of requiring ICU care, a result that is consistent with a study conducted in Colombia (Bogota ´), where the score was associated with a greater risk of disease severity (for each 1-point increase, (HR:1.15; 95%CI:1.03-1.28) [11].…”

“…In addition, some laboratory test results have been associated with an increased risk of mortality [2,9,11,15,17,19,23,33], such as elevated levels of creatinine [19,33], C-reactive protein [15,33], lactate dehydrogenase [11], transaminases [19], and D-dimer [17] or low levels of monocytes [15], lymphocytes [19], and albumin [19], among others [2,9]. In this report, significant differences were found in paraclinical testing between patients who survived and those who died, similar to that reported in the literature [11,17,23] However, paraclinical testing was not included in the multivariate models because the data were not available for all patients.…”

Baseline clinical features of COVID-19 patients, delay of hospital admission and clinical outcome: A complex relationship

“…The NOSO-COR study is an international observational, prospective, multicentric study carried out in 13 French hospitals and hospitals affiliated with the GABRIEL network [10] in order to estimate the prevalence and incidence of SARS-CoV-2 infection and to assess the associated characteristics among healthcare workers and patients. Our previous results, based on 417 patients, showed that in COVID-19 patients, age as well as delay between symptom onset and hospital admission were both associated with ICU admission [11].…”

Venerable but Vulnerable: When Centenarians Encounter Coronavirus Disease 2019

“…Finally, no centenarian was transferred to intensive care units (ICUs) in our study. As reported in our previous publication [ 8 ], rapid management, thanks to earlier presentation at hospital, and/or shortage of intensive care resources in the context of a pandemic could impact the decisions about ICU admission in this population. Considering the potential increase in the number of centenarians in the future, lessons learned from the COVID-19 pandemic should be kept in mind for better management of this population in case of a new emerging infectious disease.…”