Abstract

Objective:

This study aimed to determine the factors affecting the mortality of patients in critical condition with coronavirus disease-2019 (COVID-19) in the intensive care unit (ICU).

Materials and Methods:

We included a total of 445 patients who are admitted in the ICU due to COVID-19. Patients were divided into two groups-those who survived and those who died during the ICU follow-up-and their demographic, clinical and laboratory characteristics were compared. Factors affecting mortality were also determined.

Results:

Older age, high Kidney Disease: Improving Global Outcome (KDIGO) stage and Sequential Organ Failure Assessment (SOFA) scores at first admission to the ICU, high neutrophil/lymphocyte ratio, high D-dimer levels, low bicarbonate (HCO3) values and high lactate dehydrogenase (LDH) and creatinine levels were determined as independent risk factors for mortality in patients in critical condition with COVID-19 admitted in the ICU. Particularly, a substantial relationship was observed between the KDIGO stage and mortality during the ICU admission.

Conclusion:

Age, KDIGO stage and SOFA scores at first admission, neutrophil/lymphocyte ratio and D-dimer, HCO3, LDH and creatinine levels were independent risk factors for mortality in patients in critical condition with COVID-19 admitted in the ICU.

Keywords: Coronavirus disease 2019, ICU, kidney disease: improving global outcome, mortality, sequential organ failure assessment score

References

  1. WHO Coronavirus Disease (COVID-19) Dashboard. [cited 2020 Dec 12]. Available from URL: https://covid19.who.int/
  2. WHO Clinical management of COVID-19 [cited Oct 25 2020]. Available from URL: https://www.who.int/publications/i/item/clinical-management-of-covid-19.
  3. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-62.
  4. Luo M, Cao S, Wei L, Zhao X, Gao F, Li S, et al. Intubation, mortality, and risk factors in critically ill Covid-19 patients: A pilot study. J Clin Anesth 2020;67:110039.
  5. Zhang J, Wang X, Jia X, Li J, Hu K, Chen G, et al. Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China. Clin Microbiol Infect 2020;26:767-72.
  6. Martins-Filho PR, Tavares CSS, Santos VS. Factors associated with mortality in patients with COVID-19. A quantitative evidence synthesis of clinical and laboratory data. Eur J Intern Med 2020;76:97-9.
  7. COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med 2021;47:60-73.
  8. Du Y, Lv Y, Zha W, Zhou N, Hong X. Association of body mass index (BMI) with critical COVID-19 and in-hospital mortality: A dose-response meta-analysis. Metabolism 2021;117:154373.
  9. Yu C, Lei Q, Li W, Wang X, Liu W, Fan X, et al. Clinical Characteristics, Associated Factors, and Predicting COVID-19 Mortality Risk: A Retrospective Study in Wuhan, China. Am J Prev Med 2020;59:168-75.
  10. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ 2020;368:m1091.
  11. Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet 2020;395:1763-70.
  12. Skevaki C, Fragkou PC, Cheng C, Xie M, Renz H. Laboratory characteristics of patients infected with the novel SARS-CoV-2 virus. J Infect 2020;81:205-12.
  13. Mehraeen E, Karimi A, Barzegary A, Vahedi F, Afsahi AM, Dadras O, et al. Predictors of mortality in patients with COVID-19-a systematic review. Eur J Integr Med 2020;40:101226.
  14. Parra-Bracamonte GM, Lopez-Villalobos N, Parra-Bracamonte FE. Clinical characteristics and risk factors for mortality of patients with COVID-19 in a large data set from Mexico. Ann Epidemiol 2020;52:93-8.e2.
  15. Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review. JAMA 2020;323:1824-36.
  16. T.R. Ministry of Health COVID-19 information page. The management of Severe Pneumonia, ARDS, Sepsis and Septic Shock [cited Dec 30 2020]. Available from: https://covid19.saglik.gov.tr/
  17. Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury [Internet]. Nature Publishing Group. Vol. 2. p. 1-138; 2012. Kidney International Supplements [cited Dec 21 2020]. Available from URL: https://experts.umn.edu/en/publications/kidney-disease-improving-global-outcomes-kdigo-acute-kidney-injur.
  18. Leung C. Risk factors for predicting mortality in elderly patients with COVID-19: A review of clinical data in China. Mech Ageing Dev 2020;188:111255.
  19. Gallo Marin B, Aghagoli G, Lavine K, Yang L, Siff EJ, Chiang SS, et al. Predictors of COVID-19 severity: A literature review. Rev Med Virol 2021;31:1-10.
  20. Albitar O, Ballouze R, Ooi JP, Sheikh Ghadzi SM. Risk factors for mortality among COVID-19 patients. Diabetes Res Clin Pract 2020;166:108293.
  21. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol 2020;146:110-8.
  22. Zou X, Li S, Fang M, Hu M, Bian Y, Ling J, et al. Acute Physiology and Chronic Health Evaluation II Score as a Predictor of Hospital Mortality in Patients of Coronavirus Disease 2019. Crit Care Med 2020;48:e657-65.
  23. Yao Q, Wang P, Wang X, Qie G, Meng M, Tong X, et al. A retrospective study of risk factors for severe acute respiratory syndrome coronavirus 2 infections in hospitalized adult patients. Pol Arch Intern Med 2020;130:390-9.
  24. Kunutsor SK, Laukkanen JA. Renal complications in COVID-19: a systematic review and meta-analysis. Ann Med 2020;52:345-53.
  25. Nimkar A, Naaraayan A, Hasan A, Pant S, Durdevic M, Suarez CN, et al. Incidence and Risk Factors for Acute Kidney Injury and Its Effect on Mortality in Patients Hospitalized From COVID-19. Mayo Clin Proc Innov Qual Outcomes 2020;4:687-95.
  26. Lu L, Zhong W, Bian Z, Li Z, Zhang K, Liang B, et al. A comparison of mortality-related risk factors of COVID-19, SARS, and MERS: A systematic review and meta-analysis. J Infect 2020;81:e18-e25.
  27. Linli Z, Chen Y, Tian G, Guo S, Fei Y. Identifying and quantifying robust risk factors for mortality in critically ill patients with COVID-19 using quantile regression. Am J Emerg Med 2021;45:345-51.

Copyright and license

Copyright © 2021 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Uzundere O, Kıvılcım Kaçar C, Erdal Erbatur M, Gül MS, Akgündüz M, Korhan Z, et al. Factors Affecting the Mortality of Patients in Critical Condition with Coronavirus Disease-2019 in the Intensive Care Unit. Turk J Intensive Care. 2021;19:54-61. https://doi.org/10.4274/tybd.galenos.2021.20082