Which factors are predicting the mortality in patients with COVID-19 in the intensive care unit?

Year 2023, Volume: 4 Issue: 4, 368 - 372, 30.08.2023

Ümit Murat Parpucu , Sema Turan , Hayriye Cankar Dal , Damla Tosun , Kudret Yasemin Yalnız , Semih Aydemir , Dilek Öztürk Kazancı

https://doi.org/10.47582/jompac.1333211

Abstract

Aims: COVID-19 infection is a global health problem; clinical and laboratory parameters have been developed to predict this disease-related mortality/morbidity. Some of these parameters are clinical parameters, while some are laboratory parameters. This study aims to determine whether Acute Physiology and Chronic Health Evaluation (APACHE) II, Glasgow Coma Scale (GCS), age, presence of comorbidity, and absolute lymphocyte count effectively predict mortality in patients admitted to intensive care unit (ICU) due to COVID-19.
Methods: We have included 108 PCR-positive COVID-19 patients admitted to the ICU between 1 October and 31 November 2020 in our research. Demographic characteristics of all patients, APACHE II values within the first 24 hours of admission to ICU, the GCS, the presence of comorbidity, lymphocyte count during ICU admission, duration of ICU stay, and the mortality rates were recorded.
Results: The average age of 108 individuals evaluated in the study was 67±13.61 years, and 56.5% of the patient group consisted of the geriatric age range. Seventy (64.8%) of the patients were female, eighty-nine (82.4%) patients had at least one comorbidity. In the multivariate analysis, it was determined that lymphocyte value, APACHE II score, and the presence of any comorbidity are independent prognostic factors for mortality when accepted to ICU.
Conclusion: In our study, we have determined that age, APACHE II value, presence of comorbidity, and baseline lymphocyte counts are independent predictors of mortality.

Keywords

Mortality, Covid-19, Intensive Care Unit

COVID-19 hastalarında yoğun bakım izleminde mortaliteyi predikte eden faktörler nelerdir?

Abstract

Amaç: COVID-19 enfeksiyonu küresel bir sağlık sorunudur; bu hastalığa bağlı mortalite/morbiditeyi tahmin etmek için klinik ve laboratuvar parametreleri geliştirilmiştir. Bu parametrelerin bir kısmı klinik parametreler iken bir kısmı da laboratuvar parametreleridir. Bu çalışma, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE) II, Glasgow Koma Skalası (GKS), yaş, komorbidite varlığı ve mutlak lenfosit sayısının COVID-19 nedeniyle yoğun bakım ünitesine (YBÜ) başvuran hastalarda mortaliteyi etkili bir şekilde tahmin edip etmediğini belirlemeyi amaçlamaktadır.
Gereç-yöntem: Araştırmamıza 1 Ekim – 31 Kasım 2020 tarihleri arasında yoğun bakım ünitesine yatırılan PCR pozitif 108 COVID-19 hastasını dahil ettik. Tüm hastaların demografik özellikleri, yoğun bakıma yatıştan sonraki ilk 24 saat içindeki APACHE II değerleri, GKS, ek hastalık varlığı, yoğun bakıma yatış sırasındaki lenfosit sayısı, yoğun bakımda kalış süresi ve ölüm oranları kaydedildi.
Bulgular: Çalışmada değerlendirilen 108 kişinin yaş ortalaması 67±13,61 idi ve hasta grubunun %56,5'i geriatrik yaş aralığındaydı. Hastaların 70'i (%64,8) kadındı, 89'unda (%82,4) en az bir ek hastalık vardı. Çok değişkenli analizde lenfosit değeri, APACHE II skoru ve herhangi bir komorbiditenin varlığının YBÜ'ye kabul edildiğinde mortalite için bağımsız prognostik faktörler olduğu belirlendi.
Sonuç: Çalışmamızda; yaş, APACHE II değeri, komorbidite varlığı ve başlangıçtaki lenfosit sayılarının mortalitenin bağımsız belirleyicileri olduğunu belirledik.

Keywords

Mortalite, Covid-19, Yoğun Bakım Ünitesi

References

• Gralinski LE, Menachery VD. Return of the Coronavirus: 2019-nCoV. Viruses. 2020;12(2):135. doi:10.3390/v12020135
• Immovilli P, Morelli N, Antonucci E, Radaelli G, Barbera M, Guidetti D. COVID-19 mortality and ICU admission: the Italian experience. Crit Care. 2020;24(1):228. doi:10.1186/s13054-020-02957-9
• Mejdoubi M, Kyndt X, Djennaoui M. ICU admissions and in-hospital deaths linked to COVID-19 in the Paris region are correlated with previously observed ambient temperature. PLoS One. 2020;15(11):e0242268. doi:10.1371/journal.pone.0242268
• Girgin S, Aksun M, Tüzen AS, et al. Effects of comorbidities associated with COVID-19 cases in Intensive Care Unit on mortality and disease progression. Eur Rev Med Pharmacol Sci. 2023;27(8):3753-3765. doi:10.26355/eurrev_202304_32174
• Zhang X, Li S, Niu S. ACE2 and COVID-19 and the resulting ARDS. Postgrad Med J. 2020;96(1137):403-407. doi:10.1136/postgradmedj-2020-137935
• Lee H, Lim CW, Hong HP, et al. Efficacy of the APACHE II score at ICU discharge in predicting post-ICU mortality and ICU readmission in critically ill surgical patients. Anaesth Intensive Care. 2015;43(2):175-186. doi:10.1177/0310057X1504300206
• Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med. 2020;58(7):1131-1134. doi:10.1515/cclm-2020-0198
• Fan BE, Chong VCL, Chan SSW, et al. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020;95(6):E131-E134. doi:10.1002/ajh.25774
• Pourbagheri-Sigaroodi A, Bashash D, Fateh F, Abolghasemi H. Laboratory findings in COVID-19 diagnosis and prognosis. Clin Chim Acta. 2020;510:475-482. doi:10.1016/j.cca.2020.08.019
• Vallipuram T, Schwartz BC, Yang SS, Jayaraman D, Dial S. External validation of the ISARIC 4C Mortality Score to predict in-hospital mortality among patients with COVID-19 in a Canadian intensive care unit: a single-centre historical cohort study. Can J Anaesth. 2023;70(8):1362-1370. doi:10.1007/s12630-023-02512-4
• Moreno RP, Nassar AP Jr. Is APACHE II a useful tool for clinical research?. O APACHE II é uma ferramenta útil para pesquisa clínica?. Rev Bras Ter Intensiva. 2017;29(3):264-267. doi:10.5935/0103-507X.20170046
• Zimmerman JE, Kramer AA, McNair DS, Malila FM. Acute Physiology and Chronic Health Evaluation (APACHE) IV: hospital mortality assessment for today's critically ill patients. Crit Care Med. 2006;34(5):1297-1310. doi:10.1097/01.CCM.0000215112.84523.F0
• Wendel Garcia PD, Fumeaux T, Guerci P, et al. Prognostic factors associated with mortality risk and disease progression in 639 critically ill patients with COVID-19 in Europe: Initial report of the international RISC-19-ICU prospective observational cohort. E Clinical Medicine. 2020;25:100449. doi:10.1016/j.eclinm.2020.100449
• Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-1581. doi:10.1001/jama.2020.5394
• Zou X, Li S, Fang M, 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(8):e657-e665. doi:10.1097/CCM.0000000000004411
• Fällmar D, Rostami E, Kumlien E, et al. The extent of neuroradiological findings in COVID-19 shows correlation with blood biomarkers, Glasgow coma scale score and days in intensive care. J Neuroradiol. 2022;49(6):421-427. doi:10.1016/j.neurad.2021.11.003
• Veiga VC, Cavalcanti AB. Age, host response, and mortality in COVID-19. Eur Respir J. 2023;62(1):2300796. doi:10.1183/13993003.00796-2023
• Miller EJ, Linge HM. Age-related changes in immunological and physiological responses following pulmonary challenge. Int J Mol Sci. 2017;18(6):1294. doi:10.3390/ijms18061294
• Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481. doi:10.1016/S2213-2600(20)30079-5
• Zhou F, Yu T, Du R, 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(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3
• Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-943. doi:10.1001/jamainternmed.2020.0994
• Du RH, Liang LR, Yang CQ, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020;55(5):2000524. doi:10.1183/13993003.00524-2020
• Sabanoglu C, Inanc IH, Polat E, Peker SA. Long-term predictive value of cardiac biomarkers in patients with COVID-19 infection. Eur Rev Med Pharmacol Sci. 2022;26(17):6396-6403. doi:10.26355/eurrev_202209_29667
• Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-513. doi:10.1016/S0140-6736(20)30211-7
• Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5
• Frater JL, Zini G, d'Onofrio G, Rogers HJ. COVID-19 and the clinical hematology laboratory. Int J Lab Hematol. 2020;42 Suppl 1(Suppl 1):11-18. doi:10.1111/ijlh.13229
• Xu XW, Wu XX, Jiang XG, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020;368:m606. doi:10.1136/bmj.m606
• Buoro S, Di Marco F, Rizzi M, et al. Papa Giovanni XXIII Bergamo Hospital at the time of the COVID-19 outbreak: Letter from the warfront…. Int J Lab Hematol. 2020;42 Suppl 1:8-10. doi:10.1111/ijlh.13207