Baseline characteristics and outcomes of patients with COVID-19 admitted to intensive care units in Vancouver, Canada: a case series

Mitra, Anish R; Fergusson, Nicholas A; Lloyd‐Smith, Elisa; Wormsbecker, Andrew; Foster, Denise; Karpov, Andrei; Crowe, Sarah; Haljan, Greg; Chittock, Dean R.; Kanji, Hussein D.; Sekhon, Mypinder S.; Griesdale, Donald

doi:10.1503/cmaj.200794

Cited by 124 publications

(179 citation statements)

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“…In another series of patients in Milan, Italy, the mortality was 23% and 31% had been discharged [10]. In Vancouver, Canada, the mortality in ICU patients was 15.4% [11]. In our study, the mortality was about 6.25% which was relatively lower.…”

Section: Discussioncontrasting

confidence: 42%

Safety and Feasibility of Umbilical Cord Mesenchymal Stem Cells in Patients with COVID-19 Pneumonia: A Pilot Study

Feng

Huang

et al. 2020

Preprint

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Background: We aim to explore the safety and feasibility of umbilical cord mesenchymal stem cells (UC-MSCs) transplantation in severe and critically severe type Coronavirus disease 2019 (COVID-19) patients.Methods: In addition to normal therapy, we performed four times transplantation of UC-MSCs in 16 severe and critically severe type COVID-19 patients. We observed adverse events from enrollment to D28. We evaluated the oxygenation index, inflammatory biomarkers, chest imaging, lymphocyte subsets count et al on the 7th day (D7±1 day), the 14th day (D14±1 day) and the 28th day (D28±3 days).Results: There were no infusion-related or allergic reactions. The oxygenation index was improved after transplantation. The mortality of enrolled patients was 6.25%. The level of cytokines estimated was varied in normal range, the chest imaging was improved, the lymphocyte count and lymphocyte subsets count were recovered after transplantation.Conclusions: Intravenous transplantation of UC-MSCs was safe and feasible for treatment in patients with COVID-19 pneumonia.Trial registration: Clinical Trial, NCT04269525. Registered 7 February 2020. https://clinicaltrials.gov/ct2/show/NCT04269525

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Section: Discussioncontrasting

confidence: 42%

Safety and Feasibility of Umbilical Cord Mesenchymal Stem Cells in Patients with COVID-19 Pneumonia: A Pilot Study

Feng

Huang

et al. 2020

Preprint

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“…7 COVID-19 initial symptoms are not speci c, presenting with fever, and cough, which can then resolve spontaneously or progress to shortness of breath, dyspnoea, and pneumonia, leading to severe acute respiratory syndrome (SARS), renal failure, coagulation dysfunction, multiple organ failure and death. [8][9][10][11][12][13][14] Asymptomatic patients or patients with mild or moderate symptoms were mainly found by testing of those who had contacted patients con rmed with COVID-19, or had been to or had contacted with visitors from Wuhan, or had no identi able exposure but had some COVID-19 related symptoms.…”

mentioning

confidence: 99%

“…Age, comorbidities, c-reactive protein, albumin, cytokine, lactate dehydrogenase, D-dimer, albumin, platelet, lymphocyte, neutrophil, smoking, cough, expectoration, chest pain, dyspnea, CT manifestations, et al, have been reported to be associated with the severity of COVID-19 in some small studies in China, [15][16][17][18][19][20][21] and other countires. 13,22,23 Jiangsu, a province in China over 600 km from Hubei without common geographical borders and 80 million population, reported over 600 patients infected with COVID-19. We report here an analysis of all cases in Jiangsu province from the 10 th January 2020 to the 15 th March 2020 to describe the epidemiological and clinical characteristics of cases and to identify risk factors for severe/critically ill COVID-19 presentation.…”

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confidence: 99%

Clinical characteristics and risk factors of patients with severe COVID-19 in Jiangsu province, China: a retrospective multicentre cohort study

Liu

Luo²,

Wang³

et al. 2020

Preprint

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Background: Coronavirus Disease-2019 (COVID-19) has become a major health event that endangers people health throughout China and the world. Understanding the factors associated with COVID-19 disease severity could support the early identification of patients with high risk for disease progression, inform prevention and control activities, and potentially reduce mortality. This study aims to describe the characteristics of patients with COVID-19 and factors associated with severe or critically ill presentation.Methods: Multicentre retrospective cohort study of all individuals with confirmed Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infections diagnosed at 24 COVID-19-designated hospitals in Jiangsu province between the 10th January and 15th March 2020. Demographic, clinical, laboratory, and radiological data were collected at hospital admission and data on disease severity were collected at from admission. Patients were categorised as asymptomatic/mild/moderate, and severe/critically ill according to the worst level of COVID-19 recorded during hospitalisation.Results: A total of 625 patients, 64 (10.2%) were severe/critically ill and 561 (89.8%) were asymptomatic/mild/moderate. All patients were discharged and no patients died. Patients with severe/critically ill COVID-19 were more likely to be older, to be single onset (i.e. not to a cluster of cases in family/community), to have a medical history of hypertension and diabetes; had higher temperature, faster respiratory rates, lower peripheral capillary oxygen saturation (SpO2), and higher CT image quadrant scores and pulmonary opacity percentage; had increased C-reactive protein, fibrinogen, and D-dimer on admission; and had lower white blood cells, lymphocyte, and platelet counts and albumin on admission than asymptomatic/mild/moderate cases. Multivariable regression showed that odds of being a severe/critically ill case were associated with age (year) (OR 1.06, 95%CI 1.03-1.09), lymphocyte count (109/L) (OR 0.25, 95%CI 0.08-0.74), and pulmonary opacity in CT (per 5%) on admission (OR 1.31, 95%CI 1.15-1.51).Conclusions: Severe or critically ill patients with COVID-19 is about one-tenths of patients in Jiangsu. Age, lymphocyte count, and pulmonary opacity in CT on admission were associated with risk of severe or critically ill COVID-19.

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“…Preexisting comorbidities are prevalent among COVID-19 patients, especially in critical cases. According to a most last case series in Canada, at least one comorbidity was present in 73.5% COVID-19 patients who was admitted to intensive care unit (ICU) (1). The in-hospital death rates of COVID-19 patients are reported to range from 0.4-49.0%, which is correlated with preexisting comorbidities (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Mediating Effect of Deteriorated Kidney Function in Comorbidity-related Excess Deaths in COVID-19: A Retrospective Cohort Study

Luo

Liu

Xie

et al. 2020

Preprint

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Background In-hospital death risks vary in COVID-19 patients with comorbidities. Kidney function decline is prevalent in this course. Methods To explore the exact role of deteriorated kidney function, we applied a retrospective cohort study including 1266 participants in Wuhan Tongren Hospital between January 27 and March 3, 2020. Demographic characteristics, preexisting comorbidities history, organ function data and outcomes were extracted. Deteriorated kidney function was identified as the decline percentage, assessed by an increase in peak serum creatinine from the baseline. Mediating effect was calculated by mediation analysis. Key Results 1266 hospitalized COVID-19 patients (60±15 years, 47.8% are male) were included, with an overall in-hospital death rate of 4.42% (56/1266). For critical cases, 77.02% had at least one preexisting comorbidity. Patients with comorbidities suffered higher in-hospital death and more severe decline of kidney function. Compared to patients with minor function decline (<10%), significant risk increase was found in those with more severe one (OR 3.57; 95%CI 1.70 to 7.52; P=.001 for moderate with 10-50% decline, and 37.45; 95%CI 18.71 to 74.55; P＜.001 for severe with>50%). More interestingly, the mediation analysis found deteriorated kidney function played as an important mediator between different comorbidities and COVID-19 patients’ in-hospital death, with the mediation effect of 11%, 12%, 16% and 32% respectively for hypertension, COPD, CVD and CKD.Conclusions Deteriorated kidney function is strongly associated with increase of in-hospital death in COVID-19 and partially mediates the facilitating effect of preexisting comorbidities on in-hospital death. Thus, dynamic monitoring kidney function, preventing the deterioration of kidney function might be helpful to improve survival in COVID-19 patients, especially those with preexisting comorbidities.

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Baseline characteristics and outcomes of patients with COVID-19 admitted to intensive care units in Vancouver, Canada: a case series

Cited by 124 publications

References 13 publications

Safety and Feasibility of Umbilical Cord Mesenchymal Stem Cells in Patients with COVID-19 Pneumonia: A Pilot Study

Safety and Feasibility of Umbilical Cord Mesenchymal Stem Cells in Patients with COVID-19 Pneumonia: A Pilot Study

Clinical characteristics and risk factors of patients with severe COVID-19 in Jiangsu province, China: a retrospective multicentre cohort study

Mediating Effect of Deteriorated Kidney Function in Comorbidity-related Excess Deaths in COVID-19: A Retrospective Cohort Study

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