Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy
Giacomo Grasselli,Massimiliano Greco,Alberto Zanella,G. Albano,Massimo Antonelli,Giacomo Bellani,E. Bonanomi,Luca Cabrini,Eleonora Carlesso,Gian Paolo Castelli,S. Cattaneo,Danilo Cereda,S. Colombo,A. Coluccello,G. Crescini,A. Forastieri Molinari,Giuseppe Foti,Roberto Fumagalli,Giorgio Antonio Iotti,Thomas Langer,Nicola Latronico,F. L. Lorini,Francesco Mojoli,Giuseppe Natalini,C. M. Pessina,Vito Marco Ranieri,R. Rech,Luigia Scudeller,Antonio Rosano,Enrico Storti,B. T. Thompson,Marcello Tirani,Paola Villani,Antonio Pesenti,Maurizio Cecconi +34 more
TLDR
The independent risk factors associated with mortality were evaluated with a multivariable Cox proportional hazards regression and infection with severe acute respiratory syndrome coronavirus 2 was confirmed by real-time reverse transcriptase-polymerase chain reaction assay of nasopharyngeal swabs.Abstract:
Importance Many patients with coronavirus disease 2019 (COVID-19) are critically ill and require care in the intensive care unit (ICU). Objective To evaluate the independent risk factors associated with mortality of patients with COVID-19 requiring treatment in ICUs in the Lombardy region of Italy. Design, Setting, and Participants This retrospective, observational cohort study included 3988 consecutive critically ill patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinating center (Fondazione IRCCS [Istituto di Ricovero e Cura a Carattere Scientifico] Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network from February 20 to April 22, 2020. Infection with severe acute respiratory syndrome coronavirus 2 was confirmed by real-time reverse transcriptase–polymerase chain reaction assay of nasopharyngeal swabs. Follow-up was completed on May 30, 2020. Exposures Baseline characteristics, comorbidities, long-term medications, and ventilatory support at ICU admission. Main Outcomes and Measures Time to death in days from ICU admission to hospital discharge. The independent risk factors associated with mortality were evaluated with a multivariable Cox proportional hazards regression. Results Of the 3988 patients included in this cohort study, the median age was 63 (interquartile range [IQR] 56-69) years; 3188 (79.9%; 95% CI, 78.7%-81.1%) were men, and 1998 of 3300 (60.5%; 95% CI, 58.9%-62.2%) had at least 1 comorbidity. At ICU admission, 2929 patients (87.3%; 95% CI, 86.1%-88.4%) required invasive mechanical ventilation (IMV). The median follow-up was 44 (95% CI, 40-47; IQR, 11-69; range, 0-100) days; median time from symptoms onset to ICU admission was 10 (95% CI, 9-10; IQR, 6-14) days; median length of ICU stay was 12 (95% CI, 12-13; IQR, 6-21) days; and median length of IMV was 10 (95% CI, 10-11; IQR, 6-17) days. Cumulative observation time was 164 305 patient-days. Hospital and ICU mortality rates were 12 (95% CI, 11-12) and 27 (95% CI, 26-29) per 1000 patients-days, respectively. In the subgroup of the first 1715 patients, as of May 30, 2020, 865 (50.4%) had been discharged from the ICU, 836 (48.7%) had died in the ICU, and 14 (0.8%) were still in the ICU; overall, 915 patients (53.4%) died in the hospital. Independent risk factors associated with mortality included older age (hazard ratio [HR], 1.75; 95% CI, 1.60-1.92), male sex (HR, 1.57; 95% CI, 1.31-1.88), high fraction of inspired oxygen (Fio2) (HR, 1.14; 95% CI, 1.10-1.19), high positive end-expiratory pressure (HR, 1.04; 95% CI, 1.01-1.06) or low Pao2:Fio2ratio (HR, 0.80; 95% CI, 0.74-0.87) on ICU admission, and history of chronic obstructive pulmonary disease (HR, 1.68; 95% CI, 1.28-2.19), hypercholesterolemia (HR, 1.25; 95% CI, 1.02-1.52), and type 2 diabetes (HR, 1.18; 95% CI, 1.01-1.39). No medication was independently associated with mortality (angiotensin-converting enzyme inhibitors HR, 1.17; 95% CI, 0.97-1.42; angiotensin receptor blockers HR, 1.05; 95% CI, 0.85-1.29). Conclusions and Relevance In this retrospective cohort study of critically ill patients admitted to ICUs in Lombardy, Italy, with laboratory-confirmed COVID-19, most patients required IMV. The mortality rate and absolute mortality were high.read more
Citations
More filters
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study
Fei Zhou,Ting Yu,Ronghui Du,Guohui Fan,Ying Liu,Zhibo Liu,Jie Xiang,Yeming Wang,Bin Song,Xiaoying Gu,Xiaoying Gu,Lulu Guan,Yuan Wei,Li Hui,Xudong Wu,Jiuyang Xu,Shengjin Tu,Yi Zhang,Hua Chen,Bin Cao +19 more
TL;DR: Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
Journal ArticleDOI
Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial.
Bruno Martins Tomazini,Israel Silva Maia,Alexandre Biasi Cavalcanti,Otavio Berwanger,Regis Goulart Rosa,Viviane C Veiga,Alvaro Avezum,Renato D. Lopes,Flavia Regina Bueno,Maria Vitoria Aparecida Oliveira Silva,Franca Pellison Baldassare,Eduardo L. V. Costa,Ricardo Antonio Bonifácio Moura,Michele Ouriques Honorato,André Nathan Costa,Lucas P. Damiani,Thiago Lisboa,Leticia Kawano-Dourado,Fernando G. Zampieri,Guilherme B Olivato,Cassia Righy,Cristina Prata Amendola,Roberta Muriel Longo Roepke,Daniela H M Freitas,Daniel Neves Forte,Flávio Geraldo Resende Freitas,Caio C. Fernandes,Livia Maria Garcia Melro,Gedealvares F S Junior,Douglas Costa Morais,Stevin Zung,Flávia Ribeiro Machado,Luciano Cesar Pontes Azevedo,Coalition Covid Brazil Iii Investigators +33 more
TL;DR: Among patients with COVID-19 and moderate or severe ARDS, use of intravenous dexamethasone plus standard care compared with standard care alone resulted in a statistically significant increase in the number of ventilator-free days over 28 days.
Journal ArticleDOI
Pathologic Antibodies to Platelet Factor 4 after ChAdOx1 nCoV-19 Vaccination.
Marie Scully,Deepak Singh,Robert Lown,Anthony Poles,Tom Solomon,Marcel Levi,David Goldblatt,Pavel Kotoucek,William John Thomas,William Lester +9 more
TL;DR: The mainstay of control of the coronavirus disease 2019 (Covid-19) pandemic is vaccination against severe acute respiratory syndrome (SARS-CoV-2) as mentioned in this paper.
Journal ArticleDOI
Clinical characteristics and day-90 outcomes of 4244 ctritically ill adults with COVID-19: a prospective cohort study
Journal ArticleDOI
Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease
David M.G. Halpin,Gerard J. Criner,Alberto Papi,Dave Singh,Antonio Anzueto,Fernando J. Martinez,A Agusti,Claus Vogelmeier +7 more
TL;DR: An overview of the management of patients with COPD during the COVID-19 pandemic is presented and inhaled corticosteroids, long-acting bronchodilators, roflumilast, or chronic macrolides should be used as indicated for stable COPD management.
References
More filters
Journal ArticleDOI
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
Chaolin Huang,Yeming Wang,Xingwang Li,Lili Ren,Jianping Zhao,Yi Hu,Li Zhang,Guohui Fan,Jiuyang Xu,Xiaoying Gu,Zhenshun Cheng,Ting Yu,Jia'an Xia,Yuan Wei,Wenjuan Wu,Xuelei Xie,Wen Yin,Li Hui,Min Liu,Yan Xiao,Hong Gao,Li Guo,Jungang Xie,Guang-Fa Wang,Rongmeng Jiang,Zhancheng Gao,Qi Jin,Jianwei Wang,Bin Cao +28 more
TL;DR: The epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of patients with laboratory-confirmed 2019-nCoV infection in Wuhan, China, were reported.
Journal ArticleDOI
Clinical Characteristics of Coronavirus Disease 2019 in China.
Wei-jie Guan,Zhengyi Ni,Yu Hu,Wenhua Liang,Chun-Quan Ou,Jianxing He,Lei Liu,Hong Shan,Chunliang Lei,David S.C. Hui,Bin Du,Lanjuan Li,Guang Zeng,Kowk-Yung Yuen,Ruchong Chen,Chun-Li Tang,Tao Wang,Ping-Yan Chen,Jie Xiang,Shiyue Li,Jinlin Wang,Zi-jing Liang,Yi-xiang Peng,Li Wei,Yong Liu,Ya-hua Hu,Peng Peng,Jian-ming Wang,Ji-yang Liu,Zhong Chen,Gang Li,Zhi-jian Zheng,Shao-qin Qiu,Jie Luo,Chang-jiang Ye,Shao-yong Zhu,Nanshan Zhong +36 more
TL;DR: During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness, and patients often presented without fever, and many did not have abnormal radiologic findings.
Journal ArticleDOI
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.
Fei Zhou,Ting Yu,Ronghui Du,Guohui Fan,Ying Liu,Zhibo Liu,Jie Xiang,Yeming Wang,Bin Song,Xiaoying Gu,Xiaoying Gu,Lulu Guan,Yuan Wei,Li Hui,Xudong Wu,Jiuyang Xu,Shengjin Tu,Yi Zhang,Hua Chen,Bin Cao +19 more
TL;DR: Wang et al. as discussed by the authors used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death, including older age, high SOFA score and d-dimer greater than 1 μg/mL.
Journal ArticleDOI
Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China.
Dawei Wang,Bo Hu,Chang Hu,Fangfang Zhu,Xing Liu,Jing Zhang,Binbin Wang,Hui Xiang,Zhenshun Cheng,Yong Xiong,Yan Zhao,Yirong Li,Xinghuan Wang,Zhiyong Peng +13 more
TL;DR: The epidemiological and clinical characteristics of novel coronavirus (2019-nCoV)-infected pneumonia in Wuhan, China, and hospital-associated transmission as the presumed mechanism of infection for affected health professionals and hospitalized patients are described.
Journal ArticleDOI
SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor
Markus Hoffmann,Hannah Kleine-Weber,Simon Schroeder,Nadine Krüger,Tanja Herrler,Sandra Erichsen,Tobias S. Schiergens,Georg Herrler,Nai Huei Wu,Andreas Nitsche,Marcel A. Müller,Christian Drosten,Christian Drosten,Stefan Pöhlmann +13 more
TL;DR: It is demonstrated that SARS-CoV-2 uses the SARS -CoV receptor ACE2 for entry and the serine protease TMPRSS2 for S protein priming, and it is shown that the sera from convalescent SARS patients cross-neutralized Sars-2-S-driven entry.
Related Papers (5)
Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area.
Safiya Richardson,Safiya Richardson,Jamie S. Hirsch,Jamie S. Hirsch,Mangala Narasimhan,James M. Crawford,Thomas McGinn,Thomas McGinn,Karina W. Davidson,Karina W. Davidson,Douglas P. Barnaby,Douglas P. Barnaby,Lance B Becker,John Chelico,John Chelico,Stuart L. Cohen,Stuart L. Cohen,Jennifer Cookingham,Kevin Coppa,Michael A Diefenbach,Andrew J. Dominello,Joan Duer-Hefele,Louise Falzon,Jordan Gitlin,Negin Hajizadeh,Negin Hajizadeh,Tiffany G. Harvin,David Hirschwerk,Eun Ji Kim,Eun Ji Kim,Zachary Kozel,Lyndonna Marrast,Lyndonna Marrast,Jazmin N. Mogavero,Gabrielle A. Osorio,Michael Qiu,Theodoros P. Zanos +36 more
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
Chaolin Huang,Yeming Wang,Xingwang Li,Lili Ren,Jianping Zhao,Yi Hu,Li Zhang,Guohui Fan,Jiuyang Xu,Xiaoying Gu,Zhenshun Cheng,Ting Yu,Jia'an Xia,Yuan Wei,Wenjuan Wu,Xuelei Xie,Wen Yin,Li Hui,Min Liu,Yan Xiao,Hong Gao,Li Guo,Jungang Xie,Guang-Fa Wang,Rongmeng Jiang,Zhancheng Gao,Qi Jin,Jianwei Wang,Bin Cao +28 more
Clinical Characteristics of Coronavirus Disease 2019 in China.
Wei-jie Guan,Zhengyi Ni,Yu Hu,Wenhua Liang,Chun-Quan Ou,Jianxing He,Lei Liu,Hong Shan,Chunliang Lei,David S.C. Hui,Bin Du,Lanjuan Li,Guang Zeng,Kowk-Yung Yuen,Ruchong Chen,Chun-Li Tang,Tao Wang,Ping-Yan Chen,Jie Xiang,Shiyue Li,Jinlin Wang,Zi-jing Liang,Yi-xiang Peng,Li Wei,Yong Liu,Ya-hua Hu,Peng Peng,Jian-ming Wang,Ji-yang Liu,Zhong Chen,Gang Li,Zhi-jian Zheng,Shao-qin Qiu,Jie Luo,Chang-jiang Ye,Shao-yong Zhu,Nanshan Zhong +36 more