From SARS-CoV-2 hematogenous spreading to endothelial dysfunction: clinical-histopathological study of cutaneous signs of COVID-19

Abstract Background To date, very few studies on clinical-histopathological correlations of cutaneous disorders associated with COVID-19 have been conducted. Case presentation The Case 1 was a 90-year-old man, who tested positive for SARS-CoV-2 from a nasopharyngeal swab. Two days later, he was hospitalized and after eleven days transferred to Intensive Care Unit. A chest CT showed bilateral ground-glass opacities. Just that day, an erythematous maculo-papular rash appeared on trunk, shoulders and neck, becoming purpuric after few days. Histological evaluations revealed a chronic superficial dermatitis with purpuric aspects. The superficial and papillary dermis appeared edematous, with a perivascular lympho-granulocytic infiltrate and erythrocytic extravasation. At intraepithelial level, spongiosis and a granulocyte infiltrate were detected. Arterioles, capillaries and post-capillary venules showed endothelial swelling and appeared ectatic. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Regrettably, due to severe lung impairment, he died. The Case 2 was a 85-year-old man, admitted to Intensive Care Unit, where he was intubated. He had tested positive for SARS-CoV-2 from a nasopharyngeal swab two days before. A chest RX showed bilateral atypical pneumonia. After seven days, a cutaneous reddening involving trunk, upper limbs, neck and face developed, configuring a sub-erythroderma. Histological evaluations displayed edema in the papillary and superficial reticular dermis, and a perivascular lymphocytic infiltrate in the superficial dermis. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Sub-erythroderma as well as respiratory symptoms gradually improved until healing. Conclusions The endothelial swelling detected in the Case 1 could be a morphological expression of SARS-CoV-2-induced endothelial dysfunction. We hypothesize that cutaneous damage could be initiated by endothelial dysfunction, caused by SARS-CoV-2 infection of endothelial cells or induced by immune system activation. The disruption of endothelial integrity could enhance microvascular permeability, extravasation of inflammatory cells and cytokines, with cutaneous injury. The Case 2 developed a sub-erythroderma associated with COVID-19, and a non-specific chronic dermatitis was detected at histological level. We speculate that a purpuric rash could represent the cutaneous sign of a more severe coagulopathy, as highlighted histologically by vascular abnormalities, while a sub-erythroderma could be expression of viral hematogenous spreading, inducing a non-specific chronic dermatitis.

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From SARS-CoV-2 hematogenous spreading to endothelial dysfunction: clinical-histopathological study of cutaneous signs of COVID-19.

10.21203/rs.3.rs-50000/v2 ◽

2020 ◽

Author(s):

Angela Patrì ◽

Maria Vargas ◽

Pasquale Buonanno ◽

Maria Carmela Annunziata ◽

Daniela Russo ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Endothelial Dysfunction ◽

Inflammatory Cells ◽

Histopathological Study ◽

Nasopharyngeal Swab ◽

Atypical Pneumonia ◽

Reticular Dermis ◽

Vascular Abnormalities ◽

Immune System Activation

Abstract Background: To date, very few studies on clinical-histopathological correlations of cutaneous disorders associated with COVID-19 have been conducted. Case presentation: The Case 1 was a 90-year-old man, who tested positive for SARS-CoV-2 from a nasopharyngeal swab. Two days later, he was hospitalized and after eleven days transferred to Intensive Care Unit. A chest CT showed bilateral ground-glass opacities. Just that day, an erythematous maculo-papular rash appeared on trunk, shoulders and neck, becoming purpuric after few days. Histological evaluations revealed a chronic superficial dermatitis with purpuric aspects. The superficial and papillary dermis appeared edematous, with a perivascular lympho-granulocytic infiltrate and erythrocytic extravasation. At intraepithelial level, spongiosis and a granulocyte infiltrate were detected. Arterioles, capillaries and post-capillary venules showed endothelial swelling and appeared ectatic. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Regrettably, due to severe lung impairment, he died.The Case 2 was a 85-year-old man, admitted to Intensive Care Unit, where he was intubated. He had tested positive for SARS-CoV-2 from a nasopharyngeal swab two days before. A chest RX showed bilateral atypical pneumonia. After seven days, a cutaneous reddening involving trunk, upper limbs, neck and face developed, configuring a sub-erythroderma. Histological evaluations displayed edema in the papillary and superficial reticular dermis, and a perivascular lymphocytic infiltrate in the superficial dermis. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Sub-erythroderma as well as respiratory symptoms gradually improved until healing. Conclusions: The endothelial swelling detected in the Case 1 could be a morphological expression of SARS-CoV-2-induced endothelial dysfunction. We hypothesize that cutaneous damage could be initiated by endothelial dysfunction, caused by SARS-CoV-2 infection of endothelial cells or induced by immune system activation. The disruption of endothelial integrity could enhance microvascular permeability, extravasation of inflammatory cells and cytokines, with cutaneous injury. The Case 2 developed a sub-erythroderma associated with COVID-19, and a non-specific chronic dermatitis was detected at histological level. We speculate that a purpuric rash could represent the cutaneous sign of a more severe coagulopathy, as highlighted histologically by vascular abnormalities, while a sub-erythroderma could be expression of viral hematogenous spreading, inducing a non-specific chronic dermatitis.

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From SARS-CoV-2 hematogenous spreading to endothelial dysfunction: clinical-histopathological study of cutaneous signs of COVID-19

10.21203/rs.3.rs-50000/v1 ◽

2020 ◽

Author(s):

Angela Patrì ◽

Maria Vargas ◽

Pasquale Buonanno ◽

Maria Carmela Annunziata ◽

Daniela Russo ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Endothelial Dysfunction ◽

Inflammatory Cells ◽

Histopathological Study ◽

Nasopharyngeal Swab ◽

Atypical Pneumonia ◽

Reticular Dermis ◽

Vascular Abnormalities ◽

Immune System Activation

Abstract Background: To date, very few studies on clinical-histopathological correlations of cutaneous disorders associated with COVID-19 have been conducted. Case presentation: The Case 1 was a 90-year-old man, who tested positive for SARS-CoV-2 from a nasopharyngeal swab. Two days later, he was hospitalized and after eleven days transferred to Intensive Care Unit. A chest CT showed bilateral ground-glass opacities. Just that day, an erythematous maculo-papular rash appeared on trunk, shoulders and neck, becoming purpuric after few days. Histological evaluations revealed a chronic superficial dermatitis with purpuric aspects. The superficial and papillary dermis appeared edematous, with a perivascular lympho-granulocytic infiltrate and erythrocytic extravasation. At intraepithelial level, spongiosis and a granulocyte infiltrate were detected. Arterioles, capillaries and post-capillary venules showed endothelial swelling and appeared ectasic. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Regrettably, due to severe lung impairment, he died.The Case 2 was a 85-year-old man, admitted to Intensive Care Unit, where he was intubated. He had tested positive for SARS-CoV-2 from a nasopharyngeal swab two days before. A chest RX showed bilateral atypical pneumonia. After seven days, a cutaneous reddening involving trunk, upper limbs, neck and face developed, configuring a sub-erythroderma. Histological evaluations displayed edema in the papillary and superficial reticular dermis, and a perivascular lymphocytic infiltrate in the superficial dermis. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Sub-erythroderma as well as respiratory symptoms gradually improved until healing. Conclusions: The endothelial swelling detected in the Case 1 could be a morphological expression of SARS-CoV-2-induced endothelial dysfunction. We hypothesize that cutaneous damage could be initiated by endothelial dysfunction, caused by SARS-CoV-2 infection of endothelial cells or induced by immune system activation. The disruption of endothelial integrity could enhance microvascular permeability, extravasation of inflammatory cells and cytokines, with cutaneous injury. The Case 2 developed a sub-erythroderma associated with COVID-19, and a non-specific chronic dermatitis was detected at histological level. We speculate that a purpuric rash could represent the cutaneous sign of a more severe coagulopathy, as highlighted histologically by vascular abnormalities, while a sub-erythroderma could be expression of viral hematogenous spreading, inducing a non-specific chronic dermatitis.

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Antibiotic susceptibility among under-fives with severe pneumonia: a prospective study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20184696 ◽

2018 ◽

Vol 6 (1) ◽

pp. 1

Author(s):

Loganathan Palanivel ◽

Chidambaranathan Sivaprakasam ◽

Logesvar Palanisamy

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Severe Pneumonia ◽

Simple Random Sampling ◽

Multidrug Resistant ◽

Atypical Pneumonia ◽

Duration Of Stay ◽

Underdeveloped Countries ◽

Medical College ◽

A Prospective Study

Background: In underdeveloped countries, lower respiratory tract infection (LRTI) remains the leading cause of under-five mortality. Judicious use of antibiotics prevents the emergence of multidrug resistant organisms, but appropriate selection is vital in the child requiring intensive care.Methods: The study in conducted prospectively in the paediatric wards and intensive care unit, Rajah Muthiah Medical College and Hospital, Chidambaram. Fifty children were enrolled in the study using simple random sampling. Data regarding the demographic details, mean duration of stay, antibiotics given, immunisation status, intensive care unit admission and complications were collected. Statistical analysis is done using the Microsoft excel 2010.Results: The complications (n=3) is more among the female children (n=2) belonging to the age group one to two years (n=2) with mean duration of stay of more than seven days (n=2) and non-immunized for age children (n=3).Conclusions: The gram positive and atypical pneumonia in Chidambaram is found to be sensitive to aminopenicillin with penicillinase resistant penicillin and macrolide respectively.

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Evidence-based of conjunctival COVID-19 positivity: An Italian experience: Gemelli Against COVID Group

European Journal of Ophthalmology ◽

10.1177/1120672120976548 ◽

2020 ◽

pp. 112067212097654

Author(s):

Maria Cristina Savastano ◽

Gloria Gambini ◽

Alfonso Savastano ◽

Benedetto Falsini ◽

Umberto De Vico ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Chemistry ◽

Nasopharyngeal Swab ◽

Reactive Protein ◽

Italian Experience ◽

Impairment Score ◽

Pulmonary Impairment ◽

Respiratory Coronavirus ◽

D Dimer

Background: The possible transmission of severe acute respiratory coronavirus 2 (SARS-CoV-2) by tears and conjunctiva is still debated. Methods: Main outcome was to investigate the agreement between nasopharyngeal swab (NPs) and conjunctival swabs (Cs) in patients with SARS-CoV-2 infection. We divided patients into four groups: (1) NPs and Cs both negative (C−NF−), (2) NPs positive and Cs negative (NFs+Cs−), (3) NPs negative and Cs positive (NFs−Cs+), and (4) NPs and Cs both positive (NFs−Cs+). The secondary outcomes were to correlate Cs results with systemic clinical parameters such as: oxygen saturation (SpO2), dyspnea degree (DP), radiologic pulmonary impairment based on chest radiography (XR) or computed tomography (CT), blood chemistry as D-Dimer (D-Dimer), fibrinogen, ferritin, lactate dehydrogenase (LDH), and C-reactive protein (C-RP). Results: A total of 100 conjunctival swabs in 50 patients with SARS-CoV-2 have been enrolled in this interventional clinical trials. Ocular signs (conjunctivitis) were present in five patients (10%). NPs and Cs highlighted a poor level of agreement (0.025; p = 0.404). Median SpO2 levels are the highest in the NF−C− group (98%) and the lowest (90%) in the group NF+C+ ( p = 0.001). Pulmonary impairment was statistically significantly different between NFs and Cs groups ( p = 0.019). Pulmonary impairment score increased from NFs−Cs− group (3.8 ± 3.9), to NFs+Cs+ group (6.7 ± 4.1). Intensive care unit patients showed higher COVID-19 Cs positivity in conjunctiva (12.5%) against hospitalized ones (5.8%). Conclusions: In patients hospitalized for SARS-CoV-2 the virus can be detected in conjunctival swab. Intensive care unit patients may reveal a higher COVID-19 presence in the conjunctiva. The most severe pulmonary impairment can be observed in NFs and Cs positivity. Trial registration: Clinicaltrials.gov registration. Ethical committee authorization: ID number: 0013008/20

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Weil’s disease presenting as atypical pneumonia

Acute Medicine Journal ◽

10.52964/amja.0374 ◽

2014 ◽

Vol 13 (4) ◽

pp. 178-181

Author(s):

Tharmmambal Balakrishnan ◽

◽

Alice Moore ◽

Sanjay Krishnamoorthy ◽

Gary Davies ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

High Mortality ◽

Complete Resolution ◽

Atypical Pneumonia ◽

Serological Testing ◽

Respiratory Complications ◽

Weil’S Disease ◽

Weil's Disease ◽

Careful History

Leptospirosis is a disease caused by spp. Leptospira, also known as Weil’s disease if it manifests with jaundice. It can be associated with respiratory, renal, hepatic and haematological complications and most importantly carries a high mortality when untreated. We describe a case of a 53 year old man presenting with myalgia and fever in whom the diagnosis of leptospirosis was not initially considered. Following a deterioration in his condition a careful history revealed an apparent brief exposure to animal urine and subsequent grossly positive Leptospira serology. Treatment of his condition led to complete resolution after a brief stay on the intensive care unit. This case highlights the atypical nature of a presentation of Leptospirosis, its respiratory complications, and importance of serological testing in its diagnosis.

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A comparative study of biochemical parameters in mild and severe cases of COVID-19

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20214424 ◽

2021 ◽

Vol 9 (11) ◽

pp. 3402

Author(s):

Gouri A. Gulavani ◽

Smita V. Wali ◽

Sanjyoti A. Panchbudhe

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Biochemical Parameters ◽

Clinical Manifestations ◽

Severe Form ◽

Nasopharyngeal Swab ◽

Laboratory Findings ◽

Reactive Protein ◽

The Difference ◽

Severity Of The Disease

Background: COVID-19 has a range of clinical manifestations, including cough, fever, breathlessness, diarrhoea. Diagnosis of COVID-19 is commonly made through detection of SARS-CoV-2 RNA by PCR testing of a nasopharyngeal swab or other specimens. Evaluation and management of COVID-19 depend on the severity of the disease. This study was done to analyses the difference in the laboratory findings of the mild and severe cases in patients with COVID-19.Methods: In this study biochemical parameters of the patients with mild and those admitted in intensive care unit (ICU) of SKNMCGH, Pune were studied. Total 60 patients were included in this study. Standard deviation and mean were calculated from the values of biochemical parameters of COVID-19 patients in intensive care unit (ICU) and ward patients.Conclusions: We found levels of lactate dehydrogenase (LDH), C-reactive protein (CRP), Aspartate aminotransferase (AST), alanine aminotransferase (ALT), ferritin were significantly elevated in severely ill ICU admitted patients than mild patients. This may be useful for predicting progression towards a more severe form of COVID-19.

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Analysis of Deaths During the Severe Acute Respiratory Syndrome (SARS) Epidemic in Singapore: Challenges in Determining a SARS Diagnosis

Archives of Pathology & Laboratory Medicine ◽

10.5858/2004-128-195-aoddts ◽

2004 ◽

Vol 128 (2) ◽

pp. 195-204 ◽

Cited By ~ 9

Author(s):

Pek Yoon Chong ◽

Paul Chui ◽

Ai E. Ling ◽

Teri J. Franks ◽

Dessmon Y. H. Tai ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

In Situ Hybridization ◽

Severe Acute Respiratory Syndrome ◽

Forensic Medicine ◽

Diffuse Alveolar Damage ◽

Health Sciences ◽

Atypical Pneumonia ◽

Singapore General Hospital

Abstract Context.—An outbreak of severe acute respiratory syndrome (SARS), an infectious disease attributed to a novel coronavirus, occurred in Singapore during the first quarter of 2003 and led to 204 patients with diagnosed illnesses and 26 deaths by May 2, 2003. Twenty-one percent of these patients required admission to the medical intensive care unit. During this period, the Center for Forensic Medicine, Health Sciences Authority, Singapore, performed a total of 14 postmortem examinations for probable and suspected SARS. Of these, a total of 8 were later confirmed as SARS infections. Objective.—Our series documents the difficulties encountered at autopsy during the initial phases of the SARS epidemic, when the pattern of infection and definitive diagnostic laboratory criteria were yet to be established. Design.—Autopsies were performed by pathologists affiliated with the Center for Forensic Medicine, Health Sciences Authority, Singapore. Tissue was accessed and read at the Tan Tock Seng Hospital, Singapore, and at the Armed Forces Institute of Pathology, Washington, DC. Autopsy tissue was submitted to the Virology Department, Singapore General Hospital, for analysis, and in situ hybridization for the SARS coronavirus was carried out at the National Institute of Infectious Diseases, Tokyo, Japan. Results.—Thirteen of 14 patients showed features of diffuse alveolar damage. In 8 patients, no precipitating etiology was identified, and in all of these patients, we now have laboratory confirmation of coronavirus infection. Two of the 8 patients presented at autopsy as sudden unexpected deaths, while the remaining 6 patients had been hospitalized with varying lengths of stay in the intensive care unit. In 3 patients, including the 2 sudden unexpected deaths, in situ hybridization showed the presence of virally infected cells within the lung. In 4 of the 8 SARS patients, pulmonary thromboemboli were also recognized on gross examination, while one patient had marantic cardiac valvular vegetations. Conclusions.—It is unfortunate that the term atypical pneumonia has been used in conjunction with SARS. Although nonspecific by itself, the term does not accurately reflect the underlying dangers of viral pneumonia, which may progress rapidly to acute respiratory distress syndrome. We observed that the clinical spectrum of disease as seen in our autopsy series included sudden deaths. This is a worrisome finding that illustrates that viral diseases will have a spectrum of clinical presentations and that the diagnoses made for such patients must incorporate laboratory as well as clinical data.

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Effect of serial awake prone positioning on oxygenation in patients admitted to intensive care with COVID-19

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-139631 ◽

2021 ◽

pp. postgradmedj-2020-139631

Author(s):

Joseph Barker ◽

Daniel Pan ◽

David Koeckerling ◽

Alexander James Baldwin ◽

Raha West

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Retrospective Review ◽

Ground Glass ◽

First Episode ◽

Nasopharyngeal Swab ◽

Prone Positioning

IntroductionAwake prone positioning (APP) might benefit patients with COVID-19 by improving oxygenation, but it is unknown whether this improvement can be sustained with serial proning episodes.MethodsWe conducted a retrospective review of adults with COVID-19 admitted to one intensive care unit, in those who underwent APP and controls. Patients in both groups had type 1 respiratory failure requiring oxygen (but not initially intubated), confirmed SARS-CoV-2 PCR by nasopharyngeal swab and findings of multifocal ground-glass opacities on imaging. For the APP group, serial SpO2/FiO2 measurements were recorded after each proning episode.ResultsOf 77 patients admitted, 50 (65%) were excluded because they had already been intubated. Another 7 (9%) had undergone APP prior to admission. Of the remaining 20, 10 underwent APP and 10 were controls. Patients in both groups had similar demographics, subsequent intubation and survival. Of those who underwent APP, SpO2/FiO2 was most likely to increase after the first episode (before median: 152, IQR 135–185; after: median 192, IQR 156–234, p=0.04). Half of participants (5) in the APP group were unable to tolerate more than two APP episodes.ConclusionsMost patients with COVID-19 admitted to the intensive care are not suitable for APP. Of those who are, many cannot tolerate more than two episodes. Improvements in SpO2/FiO2 secondary to APP are transient and most likely in the first episode. Our findings may explain why other studies have failed to show improvements in mortality from APP despite improvements in oxygenation.

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340. Outcomes of COVID-19 in Hospitalized SOT Recipients: Experence in Colombia, South America

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.541 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S274-S274

Author(s):

Fernando Rosso ◽

Eric Tafurt

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Low Dose ◽

Glucocorticoid Therapy ◽

Nasopharyngeal Swab ◽

High Dose ◽

Icu Mortality ◽

Secondary Infections ◽

Hospital Acquired

Abstract Background SOTs (SOT) recipients with COVID-19 are considered to be at high risk of severe clinical outcomes. Several descriptive studies have reported a high frequency of intensive care unit admission and death rates. There is a lack of evidence regarding the best approach for immunosuppressive therapy in SOT recipients with COVID-19. Methods We performed a single-centered, retrospective, observational study of all SOT recipients with SARS-CoV-2 confirmed infection RT-PCR from nasopharyngeal swab specimens who were admitted to the emergency department from March 25 to September 1, 2020. Glucocorticoid therapy was administered according to the criteria of the attending physician. We classified glucocorticoid dose as low dose therapy if the patient received dexamethasone 6 mg/day or methylprednisolone 40 mg/day, and a high dose if the patient received methylprednisolone 80–160 mg/day. Specimens collected within the first 48 hours were defined coinfection, while specimens collected after 48 hours were defined as hospital-acquired superinfection. Results Of a total of 43 SOT recipients with COVID-19, 17 (39%) required intensive care unit admission. 32 (74.4%) required glucocorticoid therapy: 13 received low dose and 19 high dose. 15 (34.8%) had secondary infections. A total of 12 (27.9%) presented hospital-acquired bacterial superinfections, mostly caused by P. aeruginosa, most of isolations were from respiratory tract cultures. The median time from hospital admission to superinfection diagnosis was 9 (7-13) days. Community-acquired co-infection at COVID-19 diagnosis was documented only in 3 (6.9%) patients, mostly caused by K. Pneumoniae, all isolations were from urine culture. Glucocorticoid therapy was indicated in 32 (80%) patients, 19 received high dose and 13 low doses. Overall hospital mortality was 17.5%. ICU mortality was 41%. Overall mortality in the high dose steroids group was 37 % vs . 0% in the low dose group. Conclusion Our results showed a higher frequency of superinfection in SOT recipients with COVID-19 compared to previous reports, and higher ICU mortality. Further studies are needed to establish the best approach for glucocorticoid therapy in SOT recipients with COVID-19. Disclosures All Authors: No reported disclosures

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Paradox of Predictors in Critically ill COVID-19 Patients: Outcome of a COVID-dedicated Intensive Care Unit

10.1101/2021.04.23.21256009 ◽

2021 ◽

Author(s):

Morshed Nasir ◽

Rawshan Ara Perveen ◽

Rumana Nazneen ◽

Tahmina Zahan ◽

Sonia Nasreen Ahmad ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Demographic Data ◽

Tertiary Care ◽

Predictive Biomarkers ◽

Nasopharyngeal Swab ◽

Treatment Schedule ◽

Care Hospital ◽

Icu Stay ◽

Significant Difference

Background: The study aimed to analyze the demographic, comorbidities, biomarkers, pharmacotherapy, and ICU-stay with the mortality outcome of COVID-19 patients admitted in the intensive care unit of a tertiary care hospital in a low-middle income country, Bangladesh. Methods: The retrospective cohort study was done in Holy Family Red Crescent Medical College Hospital from May to September 2020. All 112 patients who were admitted to ICU as COVID-19 cases (confirmed by RT-PCR of the nasopharyngeal swab) were included in the study. Demographic data, laboratory reports of predictive biomarkers, treatment schedule, and duration of ICU-stay of 99 patients were available and obtained from hospital records (non-electronic) and treatment sheets, and compared between the survived and deceased patients. Results: Out of 99 patients admitted in ICU with COVID-19, 72 were male and 27 were female. The mean age was 61.08 years. Most of the ICU patients were in the 60 - 69 years of age group and the highest mortality rates (35.89%) were observed in this age range. Diabetes mellitus and hypertension were the predominant comorbidities in the deceased group of patients. A significant difference was observed in neutrophil count, creatinine and, NLR, d-NLR levels that raised in deceased patients. There was no significant difference as a survival outcome of antiviral drugs remdesivir or favipiravir, while the use of cephalosporin was found much higher in the survived group than the deceased group (46.66% vs 20.51%) in ICU. Conclusions: Susceptibility to developing critical illness due to COVID-19 was found more in comorbid males aged more than 60 years. There were wide variations of the biomarkers in critical COVID-19 patients in a different population, which put the healthcare workers into far more challenge to minimize the mortality in ICU in Bangladesh and around the globe during the peak of the pandemic.

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