Background There are large uncertainties regarding outcome of patients with COVID-19 and mechanical ventilation (MV). High mortality (50 – 97%) was proposed by some groups, leading to considerable uncertainties regarding outcome of critically ill patients with COVID-19. Objectives The aim was to investigate the characteristics and outcome of critically ill patients with COVID-19 requiring intensive Care Unit (ICU) admission and mechanical ventilation. Methods A multicentre retrospective observational cohort study at 15 hospitals in Hamburg, Germany, was performed. Critically ill adult patients with COVID-19 who completed their ICU stay between February-June 2020 were included. Patient demographics, severity of illness, ICU course were retrospectively evaluated. Results There were 223 critically ill COVID-19 patients included. The majority, 73% (n=163), were male; median age was 69 (IQR 58 - 77.5) years, with 68% (n=151) patients had at least one chronic medical condition. Their SOFA-score was median 5 ( [3] , [4] , [5] , [6] , [7] , [8] , [9] ) points on admission. Overall, 167 (75%) patients needed MV. Non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) were used in in 31 (14%) and 26 (12%) patients, respectively. Subsequent MV, due to NIV/HFNC failure, was necessary in 46 (81%) patients. Renal replacement therapy was initiated in 33% (n=72), and due to severe respiratory failure extracorporeal membrane oxygenation was necessary in 9% (n=20) of patients. Experimental antiviral-therapy was used in 9% (n=21). Complications during ICU stay were: septic shock (40%, n=90), heart failure (8%, n=17) and pulmonary embolism (6%, n=14). Length of ICU-stay was median 13 days ( [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] ), duration of MV was 15 days ( [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] ...

For patients hospitalized in intensive care units, there should be early discussion about the presence or absence of documents of these kinds and early evaluation of the patient's concrete wishes in critical situations. Future studies are needed to determine how best to assure that these documents will be correctly prepared and then given over to hospital staff so that they can take their place in the patient's record.

Background SARS-CoV-2 caused a pandemic and global threat for human health. Presence of liver injury was commonly reported in patients with coronavirus disease 2019 (COVID-19). However, reports on severe liver dysfunction (SLD) in critically ill with COVID-19 are lacking. We evaluated the occurrence, clinical characteristics and outcome of SLD in critically ill patients with COVID-19. Methods Clinical course and laboratory was analyzed from all patients with confirmed COVID-19 admitted to ICU of the university hospital. SLD was defined as: bilirubin ≥ 2 mg/dl or elevation of aminotransferase levels (> 20-fold ULN). Results 72 critically ill patients were identified, 22 (31%) patients developed SLD. Presenting characteristics including age, gender, comorbidities as well as clinical presentation regarding COVID-19 overlapped substantially in both groups. Patients with SLD had more severe respiratory failure (paO2/FiO2: 82 (58–114) vs. 117 (83–155); p < 0.05). Thus, required more frequently mechanical ventilation (95% vs. 64%; p < 0.01), rescue therapies (ECMO) (27% vs. 12%; p = 0.106), vasopressor (95% vs. 72%; p < 0.05) and renal replacement therapy (86% vs. 30%; p < 0.001). Severity of illness was significantly higher (SAPS II: 48 (39–52) vs. 40 (32–45); p < 0.01). Patients with SLD and without presented viremic during ICU stay in 68% and 34%, respectively (p = 0.002). Occurrence of SLD was independently associated with presence of viremia [OR 6.359; 95% CI 1.336–30.253; p < 0.05] and severity of illness (SAPS II) [OR 1.078; 95% CI 1.004–1.157; p < 0.05]. Mortality was high in patients with SLD compared to other patients (68% vs. 16%, p < 0.001). After adjustment for confounders, SLD was independently associated with mortality [HR3.347; 95% CI 1.401–7.999; p < 0.01]. Conclusion One-third of critically ill patients with COVID-19 suffer from SLD, which is associated with high mortality. Occurrence of viremia and severity of illness seem to contribute to occurrence of SLD and underline the multifactorial cause.