ICU outcomes of COVID-19 critically ill patients: An international comparative study

Abstract

Coronavirus disease (COVID-19) caused by the new coronavirus SARS-CoV-2 has hit the world as a global pandemic of an unprecedented scale. COVID-19 has become one of the major causes of death worldwide. It is estimated that around 5% of cases are critically ill, requiring intensive care unit (ICU) admission. As of June 29, 2020, United Arab Emirates counts 47,797 cases, with 313 deaths [1]. The observed ICU mortality rate of COVID-19 is highly variable [2-5]. Also, no studies have reported the ICU outcomes of COVID-19 critically ill patients in the United Arab Emirates. The aim was to compare the published ICU case series [2-6], including ours, to understand the reasons for the differences in ICU mortality and if it is related to different ICU management of these patients (different rates of mechanical ventilation). The institutional Ethics Committee of Cleveland Clinic Abu Dhabi approved the study (number: A-2020-035), and a waiver of informed consent was obtained. Series of ICU patients with confirmed COVID-19 infection from published cohorts were included [2-6]. Regarding our study, all consecutive adult patients admitted to our ICU between March 31 and May 10, 2020, with confirmed SARS-CoV-2 infection (virus detected by a real time reverse transcriptase-polymerase chain reaction assay of a nasopharyngeal sample) were included. De-identified data from the electronic medical record were collected. Continuous variables are expressed as mean AE SD or as median [interquartile range], and proportions were used for categorical variables. Five ICU cohorts from four different countries (China, USA, Italy, and Spain) [2-6] were included along with our case series. The mean/median age was comparable between all these reported cohorts (60-64 years) except for our report, which was lower (51 AE 13 years) (Table 1). SOFA score was similar in Atlanta and Vitoria cohorts, but was higher than observed in our study. APACHE II score was comparable between the different reports (Table 1). Mechanical ventilation (MV) rate in our patients was the same as in Seattle and Atlanta reports (75% and 76%, respectively), but higher than in the Wuhan series (42%), and lower than in Lombardy and Vitoria series (89% and 94%, respectively) (Table 1). Prone position rate was comparable in the USA, China, and Italy cohorts ($27%), higher in the Spain report (49%), but much higher in our study (79%). The use of extracorporeal membrane oxygenation (ECMO) was similar in our and Wuhan reports (11%), but much higher than in the other cohorts (Table 1). The mortality rate in Wuhan and Seattle were much higher (61% and 50%, respectively) compared with the other reported ICU cohorts ranging from 26% to 33% (Table 1 and Fig. 1). The mortality rate among patients who required MV was not reported in the

Characteristics and Risk Factors Associated With Mortality in Critically Ill Patients With COVID-19

“…In a study conducted by Yang et al [17], it was shown that there was a mortality rate of 61.5% among 52 ICU patients with COVID-19. In larger series, like multiple studies from Italy, Spain and the USA, mortality rates range from approximately 22% to 61% [20]. Nadeem et al [20] state that international differences might be explained by the fact that in some countries the pandemic arrived later.…”

“…In larger series, like multiple studies from Italy, Spain and the USA, mortality rates range from approximately 22% to 61% [20]. Nadeem et al [20] state that international differences might be explained by the fact that in some countries the pandemic arrived later. This might have given them more time to prepare, resulting in an improvement of ICU care over time for patients with COVID-19.…”

“…This might have given them more time to prepare, resulting in an improvement of ICU care over time for patients with COVID-19. In addition, it needs to be taken into account that regional differences and alternate hospital protocols can contribute to the differences in morbidity and mortality reported in the literature [20]. Also, observed mortality rates appear to vary among previous studies depending on the amount of patients that were already discharged at the moment of reporting [21].…”

“…Current data from around the world indicate that pneumonia caused by COVID-19 is much more deadly than other aetiologies like Influenza [2]. Besides this, several clinical factors appear to contribute to mortality rates, like age, SOFA score and obesity [17,20,[22][23][24].…”

Effects of Methylprednisolone on Ventilator-Free Days in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome and COVID-19: A Retrospective Study

“…Severe acute respiratory syndrome coronavirus-2 (SAR-CoV-2) responsible for the coronavirus disease 2019 (COVID-19) has hit the world as a global pandemic at an unparalleled scale, causing considerable morbidity and mortality [ 1 , 2 , 3 , 4 ]. Most people with COVID-19 have only mild or uncomplicated disease.…”