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- Title
Analysis of Predictors and Outcomes of COVID-19 Patients Requiring ICU Admission from COVID-19 Registry, India.
- Authors
Kajal, Kamal; Singla, Karan; Dutt Puri, Goverdhan; Bhalla, Ashish; Mukherjee, Aparna; Kumar, Gunjan; Turuk, Alka; Premkumar, Madhumita; Mahajan, Varun; Naik, Naveen B.; Bingi, Thrilok Chander; Bhardwaj, Pankaj; John, Mary; Menon, Geetha R.; Sahu, Damodar; Panda, Samiran; Rao, Vishnu Vardhan
- Abstract
Background: Patients admitted to intensive care units (ICUs) with severe coronavirus disease (COVID-19) are associated with high mortality. The present retrospective, multicenter study describes the predictors and outcomes of COVID-19 patients requiring ICU admission from COVID-19 Registry of Indian Council of Medical Research (ICMR), India. Materials and methods: Prospectively collected data from participating institutions were entered into the electronic National Clinical Registry of COVID-19. We enrolled patients aged >18 years with COVID-19 pneumonia requiring ICU admission between March 2020 and August 2021. Exclusion criteria were negative in RT-PCR report, death within 24 hours of ICU admission, or incomplete data. Their demographic and laboratory variables, ICU severity indices, treatment strategies, and outcomes were analyzed. Results: A total of 5,865 patients were enrolled. Overall mortality was 43.2%. Non-survivors were older (58.2 ± 15.4 vs 53.6 ± 14.7 years; p = 0.001), had multiple comorbidities (33.2% vs 29.5%, p = 0.001), had higher median D-dimer (1.56 vs 1.37, p = 0.015), higher CT severity index (16.8 ± 5.2 vs 13.5 ± 5.47, p = 0.001) and longer median hospital stay (10 vs 8 days, p = 0.001) and ICU stay (5 vs 4 days, p = 0.001), compared with survivors. On multivariate analysis, high CRP (HR 1.008, 95% CI: 1.006-1.010, p = 0.001) and high D-dimer (HR 1.089, 95% CI: 1.065-1.113, p < 0.001) were associated with invasive mechanical ventilation while older age (HR 1.19, CI: 1.001-1.038, p = 0.039) and high D-dimer (HR-1.121, CI: 1.072-1.172, p = 0.001) were independently associated with mortality and while the use of prophylactic low molecular weight heparin (LMWH) (HR 0.647, CI: 0.527-0.794, p = 0.001) lowered mortality. Conclusion: Among 5,865 COVID-19 patients admitted to ICU, mortality was 43.5%. High CRP and D-dimers were independently associated with the need for invasive mechanical ventilation while older age and high D-dimer were associated with higher mortality. The use of prophylactic LMWH independently reduced mortality.
- Subjects
INDIA; INTENSIVE care units; RESEARCH; REPORTING of diseases; LENGTH of stay in hospitals; ENOXAPARIN; C-reactive protein; COVID-19; CONFIDENCE intervals; CRITICALLY ill; MULTIVARIATE analysis; AGE distribution; PATIENTS; RETROSPECTIVE studies; ACQUISITION of data; ARTIFICIAL respiration; TREATMENT effectiveness; RISK assessment; CRITICAL care medicine; MEDICAL records; DESCRIPTIVE statistics; LOW-molecular-weight heparin; COMORBIDITY; FIBRIN fibrinogen degradation products; EVALUATION
- Publication
Indian Journal of Critical Care Medicine, 2023, Vol 27, Issue 8, p552
- ISSN
0972-5229
- Publication type
Article
- DOI
10.5005/jp-journals-10071-24496