Characteristics and Results of Critically Ill COVID-19 Patients: Insights from a Clinical Report

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease it causes, coronavirus disease 2019 (COVID-19), is an emerging health threat. As of February 2020, most cases were described in non-US health systems.

One of the first deaths in the United States was reported at Evergreen Hospital in Kirkland, Washington. Over the following weeks, multiple cases of COVID-19 were identified in the surrounding community and treated at Evergreen Hospital. Most were attributed to transmission in the US, and were related to exposures in a skilled nursing facility.

In this case series, we describe the clinical presentation, characteristics, and outcomes of incident COVID-19 cases admitted to the intensive care unit (ICU) at Evergreen Hospital to inform other physicians treating critically ill patients with COVID-19. 19.

Methods

Patients with confirmed SARS-CoV-2 infection (positive result by polymerase chain reaction test of a nasopharyngeal sample) admitted to the ICU at Evergreen Hospital between February 20, 2020 and March 5 were included. of 2020.

Evergreen Hospital is a 318-bed public hospital with a 20-bed ICU serving approximately 850,000 residents of King and Snohomish counties in Washington state.

Prior to data collection, an exemption was obtained from Evergreen Healthcare’s institutional review board. Data from deidentified patients were collected and analyzed using Stata version 15.1 (StataCorp).

Laboratory tests were reviewed at ICU admission and on day 5.
Chest radiographs were reviewed by an intensivist and a radiologist.
Patient outcome data were assessed after 5 or more days of ICU care or at the time of death.
A statistical significance analysis was not performed given the descriptive nature of the study.

Results

A total of 21 cases were included (mean age, 70 years [range, 43-92 years]; 52% men).
Comorbidities were identified in 18 cases (86%), with chronic kidney disease and congestive heart failure being the most common.
Initial symptoms included shortness of breath (76%), fever (52%), and cough (48%).
The mean onset of symptoms before presenting to the hospital was 3.5 days , and 17 patients (81%) were admitted to the ICU less than 24 hours after hospital admission.
An abnormal chest x-ray was noted in 20 patients (95%) on admission. The most common findings on initial radiography were bilateral reticular nodular opacities (11 patients [52%]) and ground-glass opacities (10 [48%]). At 72 hours, 18 patients (86%) had bilateral reticular nodular opacities and 14 (67%) had evidence of ground-glass opacities.
The mean white blood cell count was 9365 μL on admission and 14 patients (67%) had a white blood cell count in the normal range. Fourteen patients (67%) had an absolute lymphocyte count of less than 1000 cells/μl.
Liver function tests were abnormal in 8 patients (38%) on admission.
Mechanical ventilation was started in 15 patients (71%).
Acute respiratory distress syndrome ( ARDS) was observed in 15 of 15 patients (100%) requiring mechanical ventilation and 8 of 15 (53%) developed severe ARDS within 72 hours.
Although most patients had no evidence of shock , vasopressors were used for 14 patients (67%) during illness. Cardiomyopathy developed in 7 patients (33%) .
As of March 17, 2020, mortality was 67% and 24% of patients had remained in critical condition and 9.5% had been discharged from the ICU.

Characteristics and Results of Critically Ill COVI
Discussion

This study represents the first description of critically ill patients infected with SARS-CoV-2 in the United States. These patients had a high rate of ARDS and a high risk of death, similar to data published in China. However, this case series adds information on early presentation and outcomes in this population and demonstrates poor short-term outcomes among patients requiring mechanical treatment. ventilation.

It is unclear whether the high rate of cardiomyopathy in this case series reflects a direct cardiac complication of SARS-CoV-2 infection or the result of overwhelming critical illness. Others have described cardiomyopathy in COVID-19, and additional research may better characterize this risk.

Limitations of this study include the small number of patients from a single center, the study population included older residents of skilled nursing facilities, and it is likely not widely applicable to other critically ill patients.

However, this study provides some initial experiences regarding the characteristics of COVID-19 in critically ill patients in the US and emphasizes the need to limit the exposure of nursing home residents to SARS-CoV-2. .

Characteristics and Results of Critically Ill COVID-19 Patients: Insights from a Clinical Report

Clinical report detailing incident cases of critically ill COVID-19 patients admitted to the intensive care unit at Evergreen Hospital provides valuable insights to inform management strategies for critically ill individuals with COVID-19.