Clinical characteristics and risk factors for severe-critically ill COVID-19 adult patients in Jiangsu, China: a multiple-centered, retrospective study

Abstract Background A number of reports have documented the clinical characteristics of patients with severe coronavirus disease 2019 (COVID-19) in Wuhan. Clinical features of severe-critically ill COVID-19 patients in Jiangsu, outside Wuhan, remains unknown. Methods This multi-centered retrospective study collected the information of 631 laboratory-confirmed COVID-19 patients hospitalized at 28 authorized hospitals in Jiangsu province between January 23, 2019 and March 13, 2020. Epidemiological and demographic information, clinical and radiological characteristics, laboratory results and treatment of these patients were analyzed. Results A total of 583 adult patients with laboratory-confirmed COVID-19 were enrolled for final analysis, including 84 severe-critically ill patients and 499 mild-moderate patients. Median age of the severe-critically ill patients was 57.0 years [interquartile range (IQR), 49.0-65.8], and 50 (59.5%) were males. Multisystemic laboratory abnormalities were observed on admission in severe-critically ill patients. The severe-critically ill patients showed more noticeable radiologic abnormalities and more coexisting health issues as compared to mild-moderate patients. Most of the severe-critically ill COVID-19 patients become deteriorated in two weeks after diagnosis. Age [odds ratio (OR) 1.08, 95% confidence interval (CI) (1.03-1.14)], D-dimer (OR 3.21, 95% CI 1.39-7.40), and lymphocytes (OR 0.28, 95% CI 0.04-0.88) were independently associated with the progression of severe-critically illness. Conclusions Older age, higher D-dimer levels and less lymphocyte counts on admission are potential risk factors for COVID-19 patients to develop into severe and critically illness. The results would help clinicians to identify high-risk patients in advance.

Download Full-text

A meta-analysis of critically ill patients reveals several potential risk factors for delirium

General Hospital Psychiatry ◽

10.1016/j.genhosppsych.2014.05.002 ◽

2014 ◽

Vol 36 (5) ◽

pp. 488-496 ◽

Cited By ~ 25

Author(s):

Jiaping Huai ◽

Xiaohua Ye

Keyword(s):

Risk Factors ◽

Critically Ill ◽

Potential Risk ◽

Critically Ill Patients ◽

Meta Analysis ◽

Potential Risk Factors

Download Full-text

The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study

10.21203/rs.3.rs-50431/v1 ◽

2020 ◽

Author(s):

Ling Sang ◽

Sibei Chen ◽

Xia Zheng ◽

Weijie Guan ◽

Zhihui Zhang ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Retrospective Study ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Right Heart Failure ◽

Right Heart ◽

Icu Admission ◽

Incidence Risk

Abstract Background: Since the clinical correlates, prognosis and determinants of AKI in patients with Covid-19 remain largely unclear, we perform a retrospective study to evaluate the incidence, risk factors and prognosis of AKI in severe and critically ill patients with Covid-19.Methods: We reviewed medical records of all adult patients (>18 years) with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University. The clinical data, including patient demographics, clinical symptoms and signs, laboratory findings, treatment [including respiratory supports, use of medications and continuous renal replacement therapy (CRRT)] and clinical outcomes, were extracted from the electronic records, and we access the incidence of AKI and the use of CRRT, risk factors for AKI, the outcomes of renal diseases, and the impact of AKI on the clinical outcomes.Results: Among 210 subjects, 131 were males (62.4%). The median age was 64 years (IQR: 56-71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) patients were classified as stage 1, 2 and 3, respectively. 54 cases (58.7%) received CRRT. Age, sepsis, Nephrotoxic drug, IMV and elevated baseline Scr were associated with AKI occurrence. The renal recover during hospitalization among 16 AKI patients (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure and higher P/F ratio. Of 210 patients, 93 patients deceased within 28 days of ICU admission. AKI stage 3, critical disease, greater age and minimum P/F <150mmHg independently associated with it.Conclusions: Among patients with Covid-19, the incidence of AKI was high. age , sepsis, nephrotoxic drug, IMV and baseline Scr were strongly associated with the development of AKI. Time from admission to AKI diagnosis, right heart failure and P/F ratio were independently associated with the potential of renal recovery. Finally, AKI KIDGO stage 3 independently predicted the risk of death within 28 days of ICU admission.

Download Full-text

Potential risk factors for infection with Candida spp. in critically ill patients

Clinical Microbiology and Infection ◽

10.1111/j.1469-0691.2004.00873.x ◽

2004 ◽

Vol 10 (6) ◽

pp. 550-555 ◽

Cited By ~ 51

Author(s):

D. Peres-Bota ◽

H. Rodriguez-Villalobos ◽

G. Dimopoulos ◽

C. Melot ◽

J.-L. Vincent

Keyword(s):

Risk Factors ◽

Critically Ill ◽

Potential Risk ◽

Critically Ill Patients ◽

Candida Spp ◽

Potential Risk Factors

Download Full-text

CLINICAL CHARACTERISTICS, OUTCOMES AND RISK FACTORS OF CANDIDIAL INFECTIONS WITH CRITICALLY ILL PATIENTS IN RESPIRATORY INTENSIVE CARE UNIT IN TURKEY

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a1011 ◽

2015 ◽

Vol 3 (Suppl 1) ◽

pp. A1011

Author(s):

İ Erayman ◽

DM Yavşan ◽

R Altuntaş ◽

E Karataş ◽

M Göktepe ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Characteristics ◽

Respiratory Intensive Care Unit

Download Full-text

Development a Nomogram to Predict Prognosis in Severe and Critically Ill Patients with COVID-19

10.21203/rs.3.rs-34264/v1 ◽

2020 ◽

Author(s):

Weiping Tan ◽

Ying Zhu ◽

Hui Yi ◽

Yingyu Lin ◽

Yumei Liu ◽

...

Keyword(s):

Risk Factors ◽

Disease Severity ◽

Critically Ill ◽

Critically Ill Patients ◽

Poor Prognosis ◽

Total Bilirubin ◽

Lung Involvement ◽

Factors Associated ◽

Independent Risk Factors ◽

D Dimer

Abstract Background: The number of deaths caused by COVID-19 are on the rising worldwide. This study focused on severe and critically ill COVID-19, aim to explore independent risk factors associated with disease severity and to build a nomogram to predict patients’ prognosis.Methods: Patients with laboratory-confirmed COVID-19 admitted to the Union Hospital, Tongji Medical College and Hankou Hospital of Wuhan, China, from February 8th to April 6th, 2020. LASSO Regression and Multivariate Analysis were applied to screen independent factors. COX Nomogram was built to predict the 7-day, 14-day and 1-month survival probability.Results: A total of 115 severe [73 (63.5%)] and critically ill [42 (36.5%)] patients were included in this study, containing 93 (80.9%) survivors and 22 (19.1%) non-survivors. For disease severity, D-dimer [OR 6.33 (95%CI, 1.27-45.57], eosinophil percentage [OR 8.02 (95%CI, 1.82-45.04)], total bilirubin [OR 12.38 (95%CI, 1.24-223.65)] and lung involvement score [OR 1.22 (95%CI, 1.08-1.40)] were the independent factors associated with critical illness. Troponin [HR 9.02 (95%CI, 3.02, 26.97)] and total bilirubin [HR 3.16 (95%CI, 1.13, 8.85)] were the independent predictors for patients’ prognosis. Troponin≥26.2 ng/L and total bilirubin＞20 μmol/L were associated with poor prognosis. The nomogram based on the independent risk factors had a C-index of 0.92 (95%CI, 0.87, 0.98) for predicting survival probability. The survival nomogram validated in the critically ill patients had a C-index of 0.83 (95%CI: 0.75, 0.94).Conclusions: In conclusion, in severe and critically ill patients with COVID-19, D-dimer, eosinophil percentage, total bilirubin and lung involvement score were the independent risk factors associated with disease severity. The proposed survival nomogram accurately predicted prognosis. The survival analysis may suggest that early incidence of multiple organ dysfunction may be an important predictor of poor prognosis.

Download Full-text

Clinical Features and Prognosis of Invasive Ventilation in Hospitalized Patients with COVID-19: A Retrospective Study

Anesthesiology and Pain Medicine ◽

10.5812/aapm.108773 ◽

2020 ◽

Vol 10 (6) ◽

Author(s):

Poupak Rahimzadeh ◽

Hamid Reza Faiz ◽

Reza Farahmandrad ◽

Babak Hassanlouei ◽

Azadeh Habibi ◽

...

Keyword(s):

Retrospective Study ◽

Respiratory Rate ◽

Critically Ill ◽

Clinical Features ◽

Critically Ill Patients ◽

Clinical Characteristics ◽

Laboratory Data ◽

World Health ◽

The Mean ◽

Lung Ct

Background: World Health Organization (WHO) declared that the outbreak of COVID-19 constituted a public health emergency of global concern. Objectives: Owing to limited data on critically ill patients admitted to ICU, we aimed to describe the clinical characteristics and prognosis of these patients based on ventilatory variables and clinical features. Methods: In this retrospective study, 45 critically ill patients with laboratory-confirmed COVID-19 who were admitted to Intensive Care Unit (ICU) wards of the hospital from April 8 to May 9, 2020, were enrolled. Medical files of the patients were reviewed, and demographic and clinical characteristics, laboratory data, lung CT scan findings, causes of intubation, and outcomes of the patients were all collected. Results: The median age of the patients was 67 years (range 22 to 91), 64% were men, and hypertension was the most common comorbidity. History of close contact with previously confirmed patients was positive in 62.2% of the patients. The mean time from symptom onset to hospital admission was 5.98 ± 2.93 days. The most common symptoms at the onset of illness were dyspnea (95.6%), and gastrointestinal symptoms (22.2%) were rare. The average length of the intubation was 4.84 ± 3.28 days. The distribution of intubation causes in the deceased patients was significantly more than the recovered patients (P = 0.031). The mean score of lung CT involvement in deaths (370.26 ± 207.50) was significantly higher than the recovered patients (235.71 ± 81.21) (P = 0.042). Length of the intubation had a statistically direct correlation with respiratory rate (P = 0.03). Conclusions: Most of the critically ill patients admitted to ICU were older men and had poor outcomes with a high mortality rate. Furthermore, the score of chest CT involvement and respiratory rate are important prognostic factors in determining the severity of the illness, requiring ventilatory support, and outcome.

Download Full-text

Impact of Ursodeoxycholic Acid in Critically Ill Patients With Sepsis: A Retrospective Study

Journal of Pharmacy Practice ◽

10.1177/08971900211038363 ◽

2022 ◽

pp. 089719002110383

Author(s):

Khalid Al Sulaiman ◽

Abdullah Kharbosh ◽

Khalid Bin Salah ◽

Thamer Alsulaiman ◽

Norah Al Andas ◽

...

Keyword(s):

Septic Shock ◽

Retrospective Study ◽

Ursodeoxycholic Acid ◽

Critically Ill ◽

Critically Ill Patients ◽

Severity Of Illness ◽

Adult Patients ◽

P Value ◽

Icu Admission ◽

Medical City

Background: Using ursodeoxycholic acid (UDCA) in critically ill patients as adjunctive therapy for sepsis/septic shock in neonates and children is controversial, while it has not been extensively investigated in adults. This study aims to assess the effect of UDCA use on the early resolution of sepsis/septic shock in critically ill adult patients. Method: A retrospective study of critically ill adult patients in the intensive care unit (ICU) admitted with sepsis/septic shock at King Abdulaziz Medical City. Based on their usage of UDCA, patients were categorized into two groups. A total of 88 patients were included for analysis after matching, based on severity of illness scores within 24-hours of ICU admission. The primary outcome was to assess the effect of UDCA on the severity and resolution of shock at day three of ICU admission. The secondary outcomes were 30-day in-hospital mortality, mechanical ventilation (MV) duration, and ICU length of stay (LOS). Results: Out of the 88 patients matched, 44 patients (50%) received UDCA during the study period. Using UDCA was neither associated with improvement in Sequential Organ Failure Assessment (SOFA) score ( p-value: 0.32), inotropes/vasopressors requirement ( p-value: 0.79), Glasgow Coma Scale (GCS) ( p-value: 0.59) nor total bilirubin levels ( p-value: 0.79) at day three compared with the control. There was a significant association between using UDCA and improvement in PaO2/FiO2 ratio ( p-value: 0.01) and early extubation at day three ( p-value: 0.04). Conclusion: Using UDCA in critically ill patients with sepsis/septic shock was not associated with improvement in shock severity and resolution. However, patients who received UDCA were more likely to be extubated and not require MV on day three of ICU admission.

Download Full-text