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Multicenter Study
. 2020 Jul 6;24(1):394.
doi: 10.1186/s13054-020-03098-9.

Clinical course and predictors of 60-day mortality in 239 critically ill patients with COVID-19: a multicenter retrospective study from Wuhan, China

Jiqian Xu  1 , Xiaobo Yang  1   2 , Luyu Yang  3 , Xiaojing Zou  1   2 , Yaxin Wang  1 , Yongran Wu  1 , Ting Zhou  1 , Yin Yuan  1 , Hong Qi  1 , Shouzhi Fu  3 , Hong Liu  1   2 , Jia'an Xia  2 , Zhengqin Xu  4 , Yuan Yu  1 , Ruiting Li  1 , Yaqi Ouyang  1 , Rui Wang  1 , Lehao Ren  1 , Yingying Hu  1 , Dan Xu  1 , Xin Zhao  1 , Shiying Yuan  5 , Dingyu Zhang  6 , You Shang  7   8
Affiliations
Multicenter Study

Clinical course and predictors of 60-day mortality in 239 critically ill patients with COVID-19: a multicenter retrospective study from Wuhan, China

Jiqian Xu et al. Crit Care. .

Abstract

Background: The global numbers of confirmed cases and deceased critically ill patients with COVID-19 are increasing. However, the clinical course, and the 60-day mortality and its predictors in critically ill patients have not been fully elucidated. The aim of this study is to identify the clinical course, and 60-day mortality and its predictors in critically ill patients with COVID-19.

Methods: Critically ill adult patients admitted to intensive care units (ICUs) from 3 hospitals in Wuhan, China, were included. Data on demographic information, preexisting comorbidities, laboratory findings at ICU admission, treatments, clinical outcomes, and results of SARS-CoV-2 RNA tests and of serum SARS-CoV-2 IgM were collected including the duration between symptom onset and negative conversion of SARS-CoV-2 RNA.

Results: Of 1748 patients with COVID-19, 239 (13.7%) critically ill patients were included. Complications included acute respiratory distress syndrome (ARDS) in 164 (68.6%) patients, coagulopathy in 150 (62.7%) patients, acute cardiac injury in 103 (43.1%) patients, and acute kidney injury (AKI) in 119 (49.8%) patients, which occurred 15.5 days, 17 days, 18.5 days, and 19 days after the symptom onset, respectively. The median duration of the negative conversion of SARS-CoV-2 RNA was 30 (range 6-81) days in 49 critically ill survivors that were identified. A total of 147 (61.5%) patients deceased by 60 days after ICU admission. The median duration between ICU admission and decease was 12 (range 3-36). Cox proportional-hazards regression analysis revealed that age older than 65 years, thrombocytopenia at ICU admission, ARDS, and AKI independently predicted the 60-day mortality.

Conclusions: Severe complications are common and the 60-day mortality of critically ill patients with COVID-19 is considerably high. The duration of the negative conversion of SARS-CoV-2 RNA and its association with the severity of critically ill patients with COVID-19 should be seriously considered and further studied.

Keywords: Acute kidney injury; Acute respiratory syndrome; COVID-19; Mortality; Thrombocytopenia.

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Conflict of interest statement

All the authors state that there are no conflicts of interest related to this study.

Figures

Fig. 1
Fig. 1
Flowchart of study of the included patients with COVID-2019. COVID-19, coronavirus disease 2019; MV, mechanical ventilation; DNR, do-not-resuscitate
Fig. 2
Fig. 2
Clinical course of critically ill patients with COVID-19. COVID-19, coronavirus disease 2019; ARDS, acute respiratory distress syndrome AKI, acute kidney injury
Fig. 3
Fig. 3
Durations of negative conversion of SARS-CoV-2 RNA in 49 critically ill survivors. Each bar indicates one survivor and the height of bars indicates duration between symptom onset and the day of last positive test for SARS-CoV-2 RNA. The red plus markers indicate the last positive tests of SARS-CoV-2 IgM. SARS-CoV-2, severe acute respiratory coronavirus 2; COVID-19, coronavirus disease 2019
Fig. 4
Fig. 4
Survival curves of 239 critically ill patients with COVID-19. The number of patients ≥ 65 years and patients < 65 years was 112 and 127, respectively. COVID-19, coronavirus disease 2019
See this image and copyright information in PMC

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