Factors associated with mortality in patients with COVID‐19 admitted to intensive care: a systematic review and meta‐analysis

Taylor, Elliott H; Marson, Ella J; Elhadi, Muhammed; MacLeod, Kim; Yu, Yanli; Davids, R.; Boden, R.; Overmeyer, R. C.; Ramakrishnan, Rema; Thomson, David; Coetzee, J. F.; Biccard, Bruce

doi:10.1111/anae.15532

Cited by 82 publications

(83 citation statements)

References 89 publications

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“…Our finding that diabetes, underlying cardiac disease, and underlying kidney disease were risk factors for mortality in critically ill patients with COVID-19 is similar to that in a meta-analysis of 48 studies, which identified diabetes, cardiovascular disease, renal disease, respiratory disease, malignancy, hypertension, older age, and smoking to be associated with mortality [ 28 ]. We also found a higher likelihood of mortality in older patients.…”

Section: Discussionsupporting

confidence: 80%

Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia

et al. 2021

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Background: SARS-CoV-2 infection has a high mortality rate and continues to be a global threat, which warrants the identification of all mortality risk factors in critically ill patients. Methods: This is a retrospective multicenter cohort study conducted in five hospitals in the Kingdom of Saudi Arabia (KSA). We enrolled patients with confirmed SARS-COV-2 infection admitted to any of the intensive care units from the five hospitals between March 2020 and July 2020, corresponding to the peak of recorded COVID-19 cases in the KSA. Results: In total, 229 critically ill patients with confirmed SARS-CoV-2 infection were included in the study. The presenting symptoms and signs of patients who died during hospitalization were not significantly different from those observed among patients who survived. The baseline comorbidities that were significantly associated with in-hospital mortality were diabetes (62% vs. 48% among patients who died and survived (p = 0.046)), underlying cardiac disease (38% vs. 19% (p = 0.001)), and underlying kidney disease (32% vs. 12% (p < 0.001)). Conclusion: In our cohort, the baseline comorbidities that were significantly associated with in-hospital mortality were diabetes, underlying cardiac disease, and underlying kidney disease. Additionally, the factors that independently influenced mortality among critically ill COVID-19 patients were high Activated Partial Thromboplastin Time (aPTT )and international normalization ratio (INR), acidosis, and high ferritin.

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Section: Discussionsupporting

confidence: 80%

Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia

et al. 2021

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“…[50][51][52] The observed inverse correlation between current smoking status and COVID-19 severity adds to the existing literature regarding the association between current smoking and risk of SARS-CoV-2 infection, disease severity and mortality. [53][54][55][56][57] Our findings contrast with observations from other common respiratory pathogens, including Middle East Respiratory Syndrome, in which smoking has been associated with increased risk of both infection and mortality, 58 59 influenza, in which history of smoking is associated with increased risk of hospital admission, 60 and respiratory syncytial virus, in which maternal smoking is associated with increased risk of acute lower respiratory infection in children. 61 Compared with former smokers and never smokers, current smoking is associated with an increased risk of death from pneumococcal pneumonia.…”

Section: Discussioncontrasting

confidence: 89%

Effect modification by age of the association between obstructive lung diseases, smoking, and COVID-19 severity

Moschovis

Hayden

et al. 2021

BMJ Open Resp Res

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IntroductionObstructive lung diseases (asthma and chronic obstructive pulmonary disease (COPD)) and smoking are associated with greater risk of respiratory infections and hospitalisations, but conflicting data exist regarding their association with severity of COVID-19, and few studies have evaluated whether these associations differ by age.ObjectivesTo examine the associations between asthma, COPD and smoking on the severity of COVID-19 among a cohort of hospitalised patients, and to test for effect modification by age.MethodsWe performed a retrospective analysis of electronic health record data of patients admitted to Massachusetts General Hospital, assigning the maximal WHO Clinical Progression Scale score for each patient during the first 28 days following hospital admission. Using ordered logistic regression, we measured the association between maximal severity score and asthma, COPD and smoking and their interaction with age.Measurements and main resultsAmong 1391 patients hospitalised with COVID-19, we found an increased risk of severe disease among patients with COPD and prior smoking, independent of age. We also found evidence of effect modification by age with asthma and current smoking; in particular, asthma was associated with decreased COVID-19 severity among older adults, and current smoking was associated with decreased severity among younger patients.ConclusionsThis cohort study identifies age as a modifying factor for the association between asthma and smoking on severity of COVID-19. Our findings highlight the complexities of determining risk factors for COVID-19 severity, and suggest that the effect of risk factors may vary across the age spectrum.

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“…Older age and comorbidities have earlier been shown to be associated with in-hospital and intensive care mortality in COVID-19 patients [7,8]. To account for the cumulative effect of age and comorbidities, we utilized CCI for analysis [4].…”

Section: Discussionmentioning

confidence: 99%

Mortality Prediction of COVID-19 Patients at Intensive Care Unit Admission

Ganesan¹,

Mahajan²,

Singla³

et al. 2021

Cureus

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Background Coronavirus-2019 (COVID-19) patients admitted to the intensive care unit (ICU) have mortality rates between 30%-50%. Identifying patient factors associated with mortality can help identify critical patients early and treat them accordingly. Patients and methods In this retrospective study, the records of patients admitted to the COVID-19 ICU in a single tertiary care hospital from April 2020 to September 2020 were analysed. The clinical and laboratory parameters between patients who were discharged from the hospital (survival cohort) and those who died in the hospital (mortality cohort) were compared. A multivariate logistic regression model was constructed to identify parameters associated with mortality. Results A total of 147 patients were included in the study. The age of the patients was 55 (45, 64), median (IQR), years. At admission, 23 (16%) patients were on mechanical ventilation and 73 (50%) were on non-invasive ventilation. Sixty patients (40%, 95% CI: 32.8 to 49.2%) had died. Patients who died had a higher Charlson comorbidity index (CCI): 3 (2, 4) vs. 2 (1, 3), p = 0.0019, and a higher admission sequential organ failure assessment (SOFA) score: 5 (4, 7) vs. 4 (3, 4), p < 0.001. Serum urea, serum creatinine, neutrophils on differential leukocyte count, neutrophil to lymphocyte ratio (N/L ratio), D-dimer, serum lactate dehydrogenase (LDH), and C-reactive protein were higher in the mortality cohort. The ratio of partial pressure of arterial oxygen to fraction of inspired oxygen, platelet count, lymphocytes on differential leukocyte count, and absolute lymphocyte count was lower in the mortality cohort. The parameters and cut-off values used for the multivariate logistic regression model included CCI > 2, SOFA score > 4, D-dimer > 1346 ng/mL, LDH > 514 U/L and N/L ratio > 27. The final model had an area under the curve of 0.876 (95% CI: 0.812 to 0.925), p < 0.001 with an accuracy of 78%. All five parameters were found to be independently associated with mortality. Conclusions CCI, SOFA score, D-dimer, LDH, and N/L ratio are independently associated with mortality. A model incorporating the combination of these clinical and laboratory parameters at admission can predict COVID-19 ICU mortality with good accuracy.

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Factors associated with mortality in patients with COVID‐19 admitted to intensive care: a systematic review and meta‐analysis

Cited by 82 publications

References 89 publications

Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia

Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia

Effect modification by age of the association between obstructive lung diseases, smoking, and COVID-19 severity

Mortality Prediction of COVID-19 Patients at Intensive Care Unit Admission

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