Clinical Course and Outcomes of Severe Covid-19: A National Scale Study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Knowledge of the outcomes of critically ill patients is crucial for health and government officials who are planning how to address local outbreaks. The factors associated with outcomes of critically ill patients with coronavirus disease 2019 (Covid-19) who required treatment in an intensive care unit (ICU) are yet to be determined. Methods: This was a retrospective registry-based case series of patients with laboratory-confirmed SARS-CoV-2 who were referred for ICU admission and treated in the ICUs of the 13 participating centers in Israel between 5 March and 27 April 2020. Demographic and clinical data including clinical management were collected and subjected to a multivariable analysis; primary outcome was mortality. Results: This study included 156 patients (median age = 72 years (range = 22–97 years)); 69% (108 of 156) were male. Eighty-nine percent (139 of 156) of patients had at least one comorbidity. One hundred three patients (66%) required invasive mechanical ventilation. As of 8 May 2020, the median length of stay in the ICU was 10 days (range = 0–37 days). The overall mortality rate was 56%; a multivariable regression model revealed that increasing age (OR = 1.08 for each year of age, 95%CI = 1.03–1.13), the presence of sepsis (OR = 1.08 for each year of age, 95%CI = 1.03–1.13), and a shorter ICU stay(OR = 0.90 for each day, 95% CI = 0.84–0.96) were independent prognostic factors. Conclusions: In our case series, we found lower mortality rates than those in exhausted health systems. The results of our multivariable model suggest that further evaluation is needed of antiviral and antibacterial agents in the treatment of sepsis and secondary infection.

Related collections

Most cited references 15

Record: found
Abstract: found
Article: not found

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

0 comments Cited 22815 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

0 comments Cited 14095 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou, Ting Yu, Ronghui Du … (2020)

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

0 comments Cited 14088 times – based on 0 reviews      Review now

All references

Author and article information

Journal

Journal ID (nlm-ta): J Clin Med

Journal ID (iso-abbrev): J Clin Med

Journal ID (publisher-id): jcm

Title: Journal of Clinical Medicine

Publisher: MDPI

ISSN (Electronic): 2077-0383

Publication date (Electronic): 18 July 2020

Publication date Collection: July 2020

Volume: 9

Issue: 7

Electronic Location Identifier: 2282

Affiliations

[1 ]Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA

[2 ]Israel Defense Forces, Medical Corps, Tel Hasomer, Ramat Gan 01215, Israel; sorkin.alex@ 123456gmail.com (A.S.); jacopo669@ 123456gmail.com (J.C.); avishaitsur@ 123456gmail.com (A.M.T.); gevalandau@ 123456gmail.com (G.L.); elon.glassberg@ 123456gmail.com (E.G.); kesari.shani@ 123456gmail.com (S.K.); ram.gelman@ 123456gmail.com (R.G.); danyep@ 123456gmail.com (D.E.); drtarifb@ 123456gmail.com (T.B.); noamfink@ 123456gmail.com (N.F.); avi.benov@ 123456gmail.com (A.B.)

[3 ]Department of Plastic and Reconstructive Surgery, Shamir Medical Centre, Zrifin 7033001, Israel

[4 ]Medical Directorate, Ministry of Health, Jerusalem 9137001, Israel

[5 ]Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel; barakc@ 123456tlvmc.gov.il (B.C.); danaka8@ 123456gmail.com (D.K.)

[6 ]Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH 44195, USA

[7 ]Department of Medicine ‘B’, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel

[8 ]Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel; Shaul.lev124@ 123456gmail.com (S.L.); tal.hakim@ 123456gmail.com (T.R.); soroksky@ 123456gmail.com (A.S.); psinger@ 123456clalit.org.il (P.S.)

[9 ]Intensive Care, Hasharon Hospital, Rabin Medical Center, Petach Tikva 49372, Israel

[10 ]Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center–Beilinson Hospital, Petach Tikva 49372, Israel

[11 ]Intensive Care Unit, Shamir Medical Centre, Zrifin 7033001, Israel; ayanadvir@ 123456gmail.com

[12 ]Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; fridrich.lidar@ 123456gmail.com

[13 ]The Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA

[14 ]The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 5290002, Israel; mmatan@ 123456poria.health.gov.il

[15 ]Department of Emergency Medicine, Assuta Ashdod University Hospital, Ashdod 7747629, Israel

[16 ]Medical Intensive Care Unit, Hadassah-Hebrew University Medical Center Jerusalem 91120, Israel; Sigals@ 123456hadassah.org.il

[17 ]Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem 91120, Israel

[18 ]Medical Intensive Care Unit, Rambam Health Care Campus, Haifa 31096, Israel; asafmiller@ 123456gmail.com

[19 ]Department of Internal Medicine “B”, Rambam Health Care Campus, Haifa 31096, Israel

[20 ]Thoracic Surgery Division, Poriya Medical Center, Tiberias 15208, Israel; Rbenavi@ 123456pmc.gov.il

[21 ]Covid-19 Intensive Care Unit, Poriya Medical Center, Tiberias 15208, Israel

[22 ]Intensive Care Unit, Barzilai University Medical Center, Ashkelon 78278, Israel; danielj@ 123456bmc.gov.il

[23 ]Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 84101, Israel

[24 ]Department of Military Medicine, Hebrew University, Jerusalem 91120, Israel

[25 ]Respiratory & Medical (RM) Intensive Care Unit, Meir Medical Center, Kfar Saba 44821, Israel; david.dahan@ 123456clalit.org.il (D.D.); danny.a.king@ 123456gmail.com (D.A.K.)

[26 ]Pulmonary Department, Meir Medical Center, Kfar Saba 44821, Israel

[27 ]Meir Medical Center, Kfar Sava 44821, Israel; anatiba@ 123456gmail.com

[28 ]Intensive Care Department, Wolfson MC, Holon 58100, Israel

[29 ]Department of General Surgery, Kaplan Medical Center, Rehovot 76100, Israel; Traumalon@ 123456walla.com

[30 ]The Hebrew University of Jerusalem, Jerusalem 91120, Israel

[31 ]Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Israel

Author notes

[* ]Correspondence: mamit@ 123456mdanderson.org

Author information

Jacob Chen https://orcid.org/0000-0002-1941-1550

Barak Cohen https://orcid.org/0000-0001-7417-444X

Avishai M Tsur https://orcid.org/0000-0002-1564-6395

Tal Rozenblat https://orcid.org/0000-0003-3492-4642

Geva Landau https://orcid.org/0000-0002-8409-0722

Danny Epstein https://orcid.org/0000-0001-7032-7007

Moshe Matan https://orcid.org/0000-0002-8088-0460

Daniel J. Jakobson https://orcid.org/0000-0003-4196-9937

Tarif Bader https://orcid.org/0000-0002-5709-7101

Arie Soroksky https://orcid.org/0000-0002-3331-6963

Article

Publisher ID: jcm-09-02282

DOI: 10.3390/jcm9072282

PMC ID: 7408944

PubMed ID: 32708357

SO-VID: 70e6c32a-3fd0-4099-86f9-7b7f536670b1

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Clinical Course and Outcomes of Severe Covid-19: A National Scale Study

Read this article at

Abstract

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 15

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Clinical Characteristics of Coronavirus Disease 2019 in China

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Author and article information

Journal

Affiliations

Author notes

Author information

Article

History

Categories

Comments

Comment on this article

Similar content 124

Cited by 14

Most referenced authors 3,070