Evaluation of Epidemiologic, Clinical and Laboratory Findings of COVID-19 Patients in Intensive Care Units, Alzahra Hospital

Document Type : Original Article (s)

Authors

1 Professor, Anesthesiology and Critical Care Research Center, Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

4 PHD in Information science and Epistemology, Alzahara Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

5 General Practitioner, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Considering the high burden of the COVID-19 disease and the pressure that was put on the health care system, especially in the intensive care unit (ICU), the examination of variables predicting the outcome of this disease can help in better understanding of patients at risk and more useful allocation of limited resources.
Methods: Patients with COVID-19 hospitalized in the ICU of Al-Zahra Medical Center were investigated in an observational (descriptive-analytical) study. Demographic, clinical, and laboratory findings were compared to find factors affecting mortality between two groups of deceased and survived patients. A comparison of demographic, clinical, and laboratory findings was conducted to identify factors influencing mortality rates in deceased and survived patients.
Findings: 1144 patients with COVID-19 were examined in the study, of which 674 were men (58.9%) and 470 were women (41.1%). The patients were split into two groups: 432 patients (37.8%) died, and 712 patients (62.2%) survived. The variables of white blood cells (P < 0.001), neutrophil (P < 0.001), neutrophil to lymphocyte ratio (P = 0.004), blood urea nitrogen (P < 0.001), creatinine (P = 0.037), procalcitonin (P < 0.001), D-dimer (P < 0.001), length of hospitalization (P < 0.001) and oxygen therapy (P < 0.001) were directly related with mortality and the highest odd ratio was related to neutrophil count (OR = 3.59). Variables of lymphocyte
(P = 0.028), eosinophil (P < 0.001), hemoglobin (P < 0.001), platelet (P = 0.007), sodium (P < 0.001), potassium (P < 0.001), magnesium (P < 0.001), prothrombin time (P < 0.001), respiratory rate group (P < 0.022) and respiratory symptom (P < 0.032) were inversely related to mortality and the lowest odd ratio was related to magnesium (OR = 0.01).
Conclusion: Examining clinical and laboratory characteristics helps us in better evaluation of patients, recognition of risk factors involved in the progression of the disease, and better management of patients.

Highlights

Saeed Abbasi: Google Scholar, PubMed

Parviz Kashefi: Google Scholar

Soodabeh Rostami: Google Scholar, PubMed

Behjat Taheri: Google Scholar

Keywords

Main Subjects


  1. Pascarella G, Strumia A, Piliego C, Bruno F, Del Buono R, Costa F, et al. COVID-19 diagnosis and management: a comprehensive review. J Intern Med 2020; 288(2): 192-206.
  2. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395(10223): 507-13.
  3. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497-506.
  4. Gaunt ER, Hardie A, Claas ECJ, Simmonds P, Templeton KE. Epidemiology and clinical presentations of the four human coronaviruses 229E, HKU1, NL63, and OC43 detected over 3 years using a novel multiplex real-time PCR method. J Clin Microbiol 2010; 48(8): 2940-7.
  5. COVID-19 coronavirus pandemic. [Online]. [cited 2022]. Available from: URL:

https://www.worldometers.info/coronavirus/

  1. Coronavirus (COVID-19) mortality rate. [Online]. [cited 2022]; Available from: URL: https://www.worldometers.info/coronavirus/coronavirus-death-rate/#:~:text=Infection%20Fatality%20Rate%20(IFR)%20%3D,%2C%20while%2098.6%25%20recover
  2. Mitra AR, Fergusson NA, Lloyd-Smith E, Wormsbecker A, Foster D, Karpov A, et al. Baseline characteristics and outcomes of patients with COVID-19 admitted to intensive care units in Vancouver, Canada: a case series. CMAJ 2020; 192(26): E694-701.
  3. Guerrero-Romero F, Mercado M, Rodriguez-Moran M, Ramírez-Renteria C, Martínez-Aguilar G, Marrero-Rodríguez D, et al. Magnesium-to-calcium ratio and mortality from COVID-19. Nutrients 2022; 14(9): 1686.
  4. Malik P, Patel U, Mehta D, Patel N, Kelkar R, Akrmah M, et al. Biomarkers and outcomes of COVID-19 hospitalisations: systematic review and meta-analysis. BMJ Evid Based Med 2021; 26(3): 107-8.
  5. Meintrup D, Borgmann S, Seidl K, Stecher M, Jakob CEM, Pilgram L, et al. Specific risk factors for fatal outcome in critically Ill COVID-19 patients: Results from a European multicenter study. J Clin Med 2021; 10(17): 3855.
  6. Palladino M. Complete blood count alterations in COVID-19 patients: A narrative review. Biochem Med (Zagreb) 2021; 31(3): 030501.
  7. Li X, Liu C, Mao Z, Xiao M, Wang L, Qi S, et al. Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis. Crit Care 2020; 24(1): 647.
  8. Toori KU, Qureshi MA, Chaudhry A, Safdar MF. Neutrophil to lymphocyte ratio (NLR) in COVID-19: A cheap prognostic marker in a resource constraint setting. Pak J Med Sci 2021; 37(5): 1435-9.
  9. Sjöström A, Rysz S, Sjöström H, Höybye C. Electrolyte and acid-base imbalance in severe COVID-19. Endocr Connect 2021; 10(7): 805-14.
  10. Tian W, Jiang W, Yao J, Nicholson CJ, Li RH, Sigurslid HH, et al. Predictors of mortality in hospitalized COVID-19 patients: A systematic review and meta-analysis. J Med Virol 2020; 92(10):
    1875-83.
  11. Ghosn M, Attallah N, Badr M, Abdallah K, De Oliveira B, Nadeem A, et al. Severe acute kidney injury in critically Ill patients with COVID-19 admitted to ICU: Incidence, risk factors, and outcomes. J Clin Med 2021; 10(6): 1217.
  12. Ng JH, Hirsch JS, Hazzan A, Wanchoo R, Shah HH, Malieckal DA, et al; Outcomes among patients hospitalized with COVID-19 and acute kidney injury. Am J Kidney Dis 2021; 77(2): 204-15.e1.
  13. Jdiaa SS, Mansour R, El Alayli A, Gautam A, Thomas P, Mustafa RA. COVID-19 and chronic kidney disease: an updated overview of reviews.
    J Nephrol 2022; 35(1): 69-85.
  14. Nogueira SÁR, Oliveira SCS, Carvalho AFM, Neves JMC, Silva LSVD, Silva Junior GBD, et al. Renal changes and acute kidney injury in covid-19: a systematic review. Rev Assoc Med Bras (1992) 2020; 66: 112-7.
  15. Tong-Minh K, van der Does Y, Engelen S, de Jong E, Ramakers C, Gommers D, et al. High procalcitonin levels associated with increased intensive care unit admission and mortality in patients with a COVID-19 infection in the emergency department. BMC Infect Dis 2022; 22(1): 165.
  16. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395(10229): 1033-4.
  17. Feng T, James A, Doumlele K, White S, Twardzik W, Zahid K, et al. Procalcitonin levels in COVID-19 patients are strongly associated with mortality and ICU acceptance in an underserved, inner city population. Medicina (Kaunas) 2021; 57(10): 1070.
  18. Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. Clin Chim Acta 2020; 505: 190-1.
  19. Zakerkish M, Shaabanpour Fooladi M, Shahbazian HB, Ahmadi F, Peyman Payami S, Dargahi-Malamir M. Assessment of mortality rate, need for ICU admission and ventilation in COVID-19 patients with diabetes mellitus. Qatar Med J 2022; 2022(1): 9.
  20. Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med 2020; 180(10): 1345-55.
  21. Kim L, Garg S, O'Halloran A, Whitaker M, Pham H, Anderson EJ, et al. Risk factors for intensive care unit admission and in-hospital mortality among hospitalized adults identified through the US coronavirus disease 2019 (COVID-19)-associated hospitalization surveillance network (COVID-NET). Clin Infect Dis 2021; 72(9): e206-14.
  22. Abou-Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management. Thromb Res 2020; 194: 101-15.
  23. Wang Y, Lu X, Li Y, Chen H, Chen T, Su N, et al. Clinical course and outcomes of 344 intensive care patients with COVID-19. Am J Respir Crit Care Med 2020; 201(11): 1430-4.
  24. Allwood BW, Koegelenberg CF, Ngah VD, Sigwadhi LN, Irusen EM, Lalla U, et al. Predicting COVID-19 outcomes from clinical and laboratory parameters in an intensive care facility during the second wave of the pandemic in South Africa. IJID Reg 2022; 3: 242-7.
  25. Williams KJ, Bax RP, Brown H, Machin SJ. Antibiotic treatment and associated prolonged prothrombin time. J Clin Pathol 1991; 44(9): 738-41.
  26. McRae HL, Militello L, Refaai MA. Updates in anticoagulation therapy monitoring. Biomedicines 2021; 9(3): 262.
  27. Malone RW, Tisdall P, Fremont-Smith P, Liu Y, Huang XP, White KM, et al. COVID-19: famotidine, histamine, mast cells, and mechanisms. Front Pharmacol 2021; 12: 633680.
  28. Lingsma HF, Bottle A, Middleton S, Kievit J, Steyerberg EW, De Mheen PJM. Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database. BMC Health Serv Res 2018; 18(1): 116.
  29. da Costa Sousa V, da Silva MC, de Mello MP, Guimarães JAM, Perini JA. Factors associated with mortality, length of hospital stay and diagnosis of COVID-19: Data from a field hospital. J Infect Public Health 2022; 15(7): 800-5.
  30. Strauß R, Ewig S, Richter K, König T, Heller G, Bauer TT. The prognostic significance of respiratory rate in patients with pneumonia: a retrospective analysis of data from 705 928 hospitalized patients in Germany from 2010-2012. Dtsch Arztebl Int 2014; 111(29-30): 503-8.
  31. Henig O, Kaye KS. Bacterial pneumonia in older adults. Infect Dis Clin North Am 2017; 31(4): 689-713.
  32. Gupta S, Hayek SS, Wang W, Chan L, Mathews KS, Melamed ML, et al. Factors associated with death in critically ill patients with coronavirus disease 2019 in the US. JAMA Intern Med 2020; 180(11): 1436-47.
  33. Pan F, Yang L, Li Y, Liang B, Li L, Ye T, et al. Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study. Int J Med Sci 2020; 17(9): 1281-92.