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Observational Study
. 2020 Sep;46(9):1714-1722.
doi: 10.1007/s00134-020-06202-3. Epub 2020 Aug 11.

Increased mortality in patients with severe SARS-CoV-2 infection admitted within seven days of disease onset

Elie Azoulay  1   2 , Muriel Fartoukh  3   4 , Michael Darmon  5   3 , Guillaume Géri  3   6 , Guillaume Voiriot  3   4 , Thibault Dupont  5   3 , Lara Zafrani  5   3 , Lola Girodias  3   6 , Vincent Labbé  3   4 , Martin Dres  3   7 , Alexandra Beurton  3   7 , Antoine Vieillard-Baron  3   6 , Alexandre Demoule  3   7
Affiliations
Observational Study

Increased mortality in patients with severe SARS-CoV-2 infection admitted within seven days of disease onset

Elie Azoulay et al. Intensive Care Med. 2020 Sep.

Abstract

Purpose: Coronavirus disease 2019 (COVID-19) is creating an unprecedented healthcare crisis. Understanding the determinants of mortality is crucial to optimise intensive care unit (ICU) resource use and to identify targets for improving survival.

Methods: In a multicentre retrospective study, we included 379 COVID-19 patients admitted to four ICUs between 20 February and 24 April 2020 and categorised according to time from disease onset to ICU admission. A Cox proportional-hazards model identified factors associated with 28-day mortality.

Results: Median age was 66 years (53-68) and 292 (77%) were men. The main comorbidities included obesity and overweight (67%), hypertension (49.6%) and diabetes (30.1%). Median time from disease onset (i.e., viral symptoms) to ICU admission was 8 (6-11) days (missing for three); 161 (42.5%) patients were admitted within a week of disease onset, 173 (45.6%) between 8 and 14 days, and 42 (11.1%) > 14 days after disease onset; day 28 mortality was 26.4% (22-31) and decreased as time from disease onset to ICU admission increased, from 37 to 21% and 12%, respectively. Patients admitted within the first week had higher SOFA scores, more often had thrombocytopenia or acute kidney injury, had more limited radiographic involvement, and had significantly higher blood IL-6 levels. Age, COPD, immunocompromised status, time from disease onset, troponin concentration, and acute kidney injury were independently associated with mortality.

Conclusion: The excess mortality in patients admitted within a week of disease onset reflected greater non-respiratory severity. Therapeutic interventions against SARS-CoV-2 might impact different clinical endpoints according to time since disease onset.

Keywords: Acute kidney injury; Acute respiratory distress syndrome; Coronavirus; Viral infection.

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Conflict of interest statement

None of the authors has any conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Predicted mortality according to time from viral symptom onset to ICU admission
Fig. 2
Fig. 2
Survival probability according to time (in weeks) from viral symptom onset to ICU admission
Fig. 3
Fig. 3
Survival on day 28 according to severity (SOFA score at admission) and time from viral symptom onset to ICU admission
See this image and copyright information in PMC

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