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. 2022 Feb 17;11(4):1049.
doi: 10.3390/jcm11041049.

Chronic Critical Illness in Patients with COVID-19: Characteristics and Outcome of Prolonged Intensive Care Therapy

Kevin Roedl  1 , Dominik Jarczak  1 , Olaf Boenisch  1 , Geraldine de Heer  1 , Christoph Burdelski  1 , Daniel Frings  1 , Barbara Sensen  1 , Axel Nierhaus  1 , Stefan Kluge  1 , Dominic Wichmann  1
Affiliations

Chronic Critical Illness in Patients with COVID-19: Characteristics and Outcome of Prolonged Intensive Care Therapy

Kevin Roedl et al. J Clin Med. .

Abstract

The spread of SARS-CoV-2 caused a worldwide healthcare threat. High critical care admission rates related to Coronavirus Disease 2019 (COVID-19) respiratory failure were observed. Medical advances helped increase the number of patients surviving the acute critical illness. However, some patients require prolonged critical care. Data on the outcome of patients with a chronic critical illness (CCI) are scarce. Single-center retrospective study including all adult critically ill patients with confirmed COVID-19 treated at the Department of Intensive Care Medicine at the University Medical Center Hamburg-Eppendorf, Germany, between 1 March 2020 and 8 August 2021. We identified 304 critically ill patients with COVID-19 during the study period. Of those, 55% (n = 167) had an ICU stay ≥21 days and were defined as chronic critical illness, and 45% (n = 137) had an ICU stay <21 days. Age, sex and BMI were distributed equally between both groups. Patients with CCI had a higher median SAPS II (CCI: 39.5 vs. no-CCI: 38 points, p = 0.140) and SOFA score (10 vs. 6, p < 0.001) on admission. Seventy-three per cent (n = 223) of patients required invasive mechanical ventilation (MV) (86% vs. 58%; p < 0.001). The median duration of MV was 30 (17-49) days and 7 (4-12) days in patients with and without CCI, respectively (p < 0.001). The regression analysis identified ARDS (OR 3.238, 95% CI 1.827-5.740, p < 0.001) and referral from another ICU (OR 2.097, 95% CI 1.203-3.654, p = 0.009) as factors significantly associated with new-onset of CCI. Overall, we observed an ICU mortality of 38% (n = 115) in the study cohort. In patients with CCI we observed an ICU mortality of 28% (n = 46) compared to 50% (n = 69) in patients without CCI (p < 0.001). The 90-day mortality was 28% (n = 46) compared to 50% (n = 70), respectively (p < 0.001). More than half of critically ill patients with COVID-19 suffer from CCI. Short and long-term survival rates in patients with CCI were high compared to patients without CCI, and prolonged therapy should not be withheld when resources permit prolonged therapy.

Keywords: COVID-19; Coronavirus Disease 2019; ICU; SARS-CoV-2; chronic critically ill; mortality; persistent critical illness; prolonged ICU stay.

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Conflict of interest statement

K.R., D.J., O.B., G.d.H., C.B. and B.S. do not report any conflicts of interest related to this article. SK received research support from CytoSorbents and Daiichi Sankyo. He also received lecture fees from Astra, Bard, Baxter, Biotest, CytoSorbents, Daiichi Sankyo, Fresenius Medical Care, Gilead, Mitsubishi Tanabe Pharma, MSD, Pfizer, Philips and Zoll. He received consultant fees from Fresenius, Gilead, MSD and Pfizer. DW received lecture honorarium from ADVANZ (previously Correvio), AMEOS, Gilead, Kite, MSD, Pfizer and Shionogi and consultation honorarium from Eumedica, EUSA-Pharm, Gilead, Kite, Lilly, MSD, Novartis, Pfizer and Shionogi. A.N. received research funds, lecture honoraria and travel reimbursement within the last 5 years from CytoSorbents Europe, Biotest AG and ThermoFisher Scientific. D.F. reports lecture honoraria within the last 5 years from Xenios A.G. S.B. received lecture honorarium from Gettinge. No other potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
Kaplan–Meier survival estimates stratified according to patients with and without prolonged ICU stay (Log-rank: p < 0.001).
See this image and copyright information in PMC

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