Risk Factors for ICU Admission, Mechanical Ventilation and Mortality in Hospitalized Patients with COVID-19 in Hubei, China

  1. Hong Gang Ren
  2. Xingyi Guo
  3. Kevin Blighe
  4. Fang Zhu
  5. Janet Martin
  6. Luqman Bin Safdar
  7. Pengcheng Yang
  8. Dao Wen Wang
  9. Qinyong Hu
  10. Nan Huo
  11. Justin Stebbing
  12. Davy Cheng

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Abstract

To examine the risk factors for Intensive Care Unit (ICU) admission, mechanical ventilation and mortality in hospitalized patients with COVID-19.

Methods

This was a retrospective cohort study including 432 patients with laboratory-confirmed COVID-19 who were admitted to three medical centers in Hubei province from January 1 st to April 10 th 2020. Primary outcomes included ICU admission, mechanical ventilation and death occurring while hospitalized or within 30 days.

Results

Of the 432 confirmed patients, 9.5% were admitted to the ICU, 27.3% required mechanical ventilation, and 33.1% died. Total leukocyte count was higher in survivors compared with those who died (8.9 vs 4.8 × 10 9 /l), but lymphocyte counts were lower (0.6 vs 1.0 × 10 9 /l). D-dimer was significantly higher in patients who died compared to survivors (6.0ug/l vs 1.0ug/l, p<0.0001. This was also seen when comparing mechanically versus non-mechanically-ventilated patients. Other significant differences were seen in AST, ALT, LDH, total bilirubin and creating kinase. The following were associated with increased odds of death: age > 65 years (adjusted hazard ratio (HR 2.09, 95% CI 1.02-4.05), severe disease at baseline (5.02, 2.05-12.29), current smoker (1.67, 1.37-2.02), temperature >39 ° C at baseline (2.68, 1.88-4.23), more than one comorbidity (2.12, 1.62-3.09), bilateral patchy shadowing on chest CT or X-ray (3.74, 1.78-9.62) and organ failure (6.47, 1.97-26.23). The following interventions were associated with higher CFR: glucocorticoids (1.60, 1.04-2.30), ICU admission (4.92, 1.37-17.64) and mechanical ventilation (2.35, 1.14-4.82).

Conclusion

Demographics, including age over 65 years, current smoker, diabetes, hypertension, and cerebrovascular disease, were associated with increased risk of mortality. Mortality was also associated with glucocorticoid use, mechanical ventilation and ICU admission.

Take-Home Message

COVID-19 patients with risk factors were more likely to be admitted into ICU and more likely to require mechanical ventilation.

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    SciScore for 10.1101/2020.08.31.20184952: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the institutional review boards of all participating medical centers
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were conducted using SAS version 9.4 (SAS Institute, Inc.
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and Limitations: Of the currently published COVID-19 observational studies on mortality to date, the sample size of our study is among the largest. Despite that, it may still lack sufficient power to determine true associations in our analysis. Furthermore, the treatment regimens across different centers may differ, including ICU admission criteria, mechanical ventilation criteria and modalities, use of antibiotics, antivirals, and other supportive interventions. Considering the retrospective observational nature of our study, it is difficult to eliminate selection biases and remaining confounders. For this reason, conclusions regarding the risk-benefit tradeoffs for interventions including corticosteroids, antibiotics, antivirals, mechanical ventilation, and ICU admission cannot be made from this analysis. However, this analysis is the best we can provide to enlighten current outcomes related to approaches to treatment for COVID-19 that were utilized in Hubei hospitals in early 2020. Due to subgroup limitations for each comorbidity, we combined all comorbidities together for analysis. Larger studies are needed to further elucidate which patients are at most risk of death, ICU, or require mechanical ventilation by specific co-morbidities. Finally, this was a retrospective case series study that relied on abstracting data from clinical charts. Accordingly, information was limited to that provided in the charts at the time of patient care.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.08.31.20184952v1 on medRxiv