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

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.

Conservative management of COVID-19 associated hypoxaemia

“…Our escalation protocol of respiratory support measures that was based on the clinical presentation and oxygen content rather than on markers of oxygenation or the Horovitz index resulted in an intubation rate of only 10.3% and an overall mortality of 7.7%. Our mortality rate of 50% in intubated patients is comparable to previous published data [ 10 – 12 ]. The overall mortality of patients hospitalised for Sars-CoV-2 infections in Germany is 22% [ 11 ] and is thus much higher than in our study in which only hypoxemic patients were included.…”

A rapid review of the overuse of antibiotics during the COVID-19 pandemic: lessons learned and recommendations for the future

“…9,10,[14][15][16][17][18]20,23,[27][28][29][30][31][32][33] , Streptococcus spp. 9,10,[15][16][17][18]20,23,27,29,34 , Escherichia coli 9,14,16,27,28,30,31,33,34 , Klebsiella spp. 9,10,12,15,16,18,22,24,27,28,31 , Enterococcus spp.…”

“…Incidence of sepsis in patients with COVID-19 varied across the literature in the initial review, ranging from 13.5% in an ICU setting 20 to 100% in patients who did not survive 35 . There was similar variation in the reported rates of septic shock 35,36 (Table 2).…”

“…There was similar variation in the reported rates of septic shock 35,36 (Table 2). Sepsis was widely recognised as a predictor of patient mortality 20,35 and bacterial sepsis in particular was correlated with far worse ICU patient outcomes than viral sepsis 37 . However, the literature neither commonly differentiated between bacterially-and virally-induced sepsis, nor reported causative microorganisms of sepsis in patients with COVID-19 20,21,36 .…”

Presenting the characteristics, smoking versus diabetes, and outcome among patients hospitalized with COVID‐19

“…Several factors have been proposed to explain the morbidity and mortality of COVID‐19 disease. Meanwhile, approximately 30%–50% of COVID‐19 patients reported having at least one comorbidity, including hypertension, diabetes, COPD, cardiovascular diseases, hepatic, and renal diseases 33,34 . Diabetic patients are more likely to have increased severity and mortality of COVID‐19.…”