Severe COVID-19 pneumonia in an intensive care setting and comparisons with historic severe viral pneumonia due to other viruses (preprint)

Purpose Severe viral pneumonia is associated with significant morbidity and mortality. Recent COVID-19 pandemic continues to impose significant health burden worldwide and individual pandemic waves often leads to a large surge in the ICU admissions for respiratory support. Comparisons of severe SARS-CoV-2 pneumonia with other seasonal and non-seasonal severe viral infections are rarely studied in an intensive care setting.Methods A retrospective cohort study comparing patients admitted to ICU with COVID-19 between March-June 2020 and those with viral pneumonias between January-December 2019. We compared patient specific demographic variables, duration of illness, ICU organ supportive measures and outcomes between both groups.Results Analysis of 93 COVID-19 (group 1) and 52 other viral pneumonia patients (group 2) showed an increased proportion of obesity (42% vs 23%, p = 0.02), non-white ethnicities (41% vs 6%, p < 0.001) and diabetes mellitus (30% vs 13%, p = 0.03) in group 1, with lower prevalence of COPD/asthma (16% vs 34%, p = 0.02). In group 1, the neutrophil to lymphocyte ratio was much lower (6.7 vs 10, p = 0.006) and invasive mechanical ventilation (58% vs 26%, p < 0.001) was more common. Length of ICU (8 vs 4, p < 0.001) and hospital stay (22 vs 11, p < 0.001) was prolonged in group 1, with no significant difference in mortality. Influenza A and rhinovirus were the most common pathogens in group 2 (26% each).Conclusions Key differences were identified within demographics (obesity, ethnicity, age, ICU scores, co-morbidities) and organ support. Despite these variations, there was no significant differences in mortality between both groups. Further studies with larger sample sizes would allow for further assessment of clinical parameters in these patients.

Vitamin-D levels and intensive care unit outcomes of a cohort of critically ill COVID-19 patients.

OBJECTIVES: The pattern of global COVID-19 has caused many to propose a possible link between susceptibility, severity and vitamin-D levels. Vitamin-D has known immune modulatory effects and deficiency has been linked to increased severity of viral infections. METHODS: We evaluated patients admitted with confirmed SARS-COV-2 to our hospital between March-June 2020. Demographics and outcomes were assessed for those admitted to the intensive care unit (ICU) with normal (>50 nmol/L) and low (<50 nmol/L) vitamin-D. RESULTS: There were 646 SARS-COV-2 PCR positive hospitalisations and 165 (25.5%) had plasma vitamin-D levels. Fifty patients were admitted to ICU. There was no difference in vitamin-D levels of those hospitalised (34, IQR 18.5-66 nmol/L) and those admitted to the ICU (31.5, IQR 21-42 nmol/L). Higher proportion of vitamin-D deficiency (<50 nmol/L) noted in the ICU group (82.0 vs. 65.2%). Among the ICU patients, low vitamin D level (<50 nmol/L) was associated with younger age (57 vs. 67 years, p=0.04) and lower cycle threshold (CT) real time polymerase chain reaction values (RT-PCR) (26.96 vs. 33.6, p=0.02) analogous to higher viral loads. However, there were no significant differences in ICU clinical outcomes (invasive and non-invasive mechanical ventilation, acute kidney injury and mechanical ventilation and hospital days) between patients with low and normal vitamin-D levels. CONCLUSIONS: Despite the association of low vitamin-D levels with low CT values, there is no difference in clinical outcomes in this small cohort of critically ill COVID-19 patients. The complex relationship between vitamin-D levels and COVID-19 infection needs further exploration with large scale randomized controlled trials.

Clinical characteristics and outcome of critically ill COVID-19 patients with Acute Kidney Injury: A single centre cohort study (preprint)

BackgroundAcute kidney injury (AKI) is a common manifestation among patients critically ill with SARS-CoV-2 infection (Coronavirus 2019) and is associated with significant morbidity and mortality. The pathophysiology of renal failure in this context is not fully understood, but likely to be multifactorial. The intensive care unit outcomes of patients following COVID-19 acute critical illness with associated AKI have not been fully explored. We conducted a cohort study to investigate the risk factors for acute kidney injury in patients admitted to and intensive care unit with COVID-19, its incidence and associated outcomes.MethodsWe reviewed the medical records of all patients admitted to our adult intensive care unit suffering from SARS-CoV-2 infection from 3rd March 2020 until 10th May 2020. Acute kidney injury was defined using the Kidney Disease Improving Global Outcome (KDIGO) criteria. The outcome analysis was assessed up to date as 15th of June 2020.ResultsA total of 81 patients admitted during this period. All patients had acute hypoxic respiratory failure and needed either noninvasive or invasive mechanical ventilatory support. Thirty-six patients (44%) had evidence of AKI (Stage I-33%, Stage II-22%, Renal Replacement Therapy (RRT)-44%). All patients with AKI stage III had RRT. Age, diabetes mellitus, immunosuppression, lymphopenia, high D-Dimer levels, increased APACHE II and SOFA scores, mechanical ventilation and use of inotropic or vasopressor support were significantly associated with AKI. The peak AKI was at day 4 and mean duration of RRT was 9 days. The mortality was 25% for the AKI group compared to 7% in those without AKI. Among those received RRT and survived their illness, the renal function recovery is complete and back to baseline in 92% of patients. Conclusion Acute kidney injury and renal replacement therapy is common in critically ill patients presenting with COVID-19. It is associated with increased severity of illness on admission to ICU, increased mortality and prolonged ICU and hospital length of stay.