ABSTRACT
Introduction: Patients with COVID-19 admitted to the ICU are at high risk of developing infectious complications during their ICU stay. Data on acquired(AI) in Portuguese critical COVID-19 patients are scarce. The aim of this study was to investigate the characteristics and risk factors for AI in critical patients with COVID-19 pneumonia admitted to the ICU. Methods: Retrospective cohort of patients with COVID-19 pneumonia admitted to an ICU in a tertiary hospital, between September 2020 and June 2021. AI considered were ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), bacteremia, CVC associated infections, urinary tract infections and soft skin tissue infections. Baseline characteristics, 3-months previous antibiotic (ATB) exposure, ATB treatment at ICU-admission and clinical management of COVID-19 pneumonia were analyzed. Results: Of the 159 patients included, with a median (IQR) age of 66 (57-72) and 63.5% males, 14 (8.8%) had no known comorbidities. A total of 63 patients(39.6%) developed AI: 45(71.4%) VAP, 20(33.3%) VAT, 28 (45.2%) UTI, 6 (9.5%) CVC associated infections and 3(4.8%) soft skin tissue infections. In univariate analysis, both SOFA score at admission (p < 0.001), acute cardiovascular (p = 0.003) and neurologic (p = 0.006) disfunction at ICU admission were associated with the development of AI. AI were also correlated to need of tracheostomy(p < 0.001), development of delirium (p < 0.001) or shock (p < 0.001);and with longer ICU and in-hospital stay (p < 0.001) and ICU and hospital mortality (p = 0.011 and p = 0.011, respectively). None of the COVID-19 pharmacologic treatments considered (remdesivir, steroids and tocilizumab), neither different regimens of ATB therapy at ICU admission were significantly associated with AI. Conclusions: In this cohort, almost 40% of the patients developed AI, that was associated with 4 times higher hazard of needing mechanical ventilation and higher rate of adverse events such as delirium, shock during in-ICU stay and longer length of ICU and in-hospital stay.
ABSTRACT
Introduction: This study aimed to determine the mortality and morbidity of COVID-19 patients in an intensive care unit (ICU) until hospital discharge, and explore the factors that influence in-ICU and in-hospital mortality rates. Methods: Single center retrospective cohort regarding COVID-19 critical patients in a tertiary hospital ICU, from September/20 to June/21. Demographic data, clinical characteristics, admission SOFA score, frailty score (FS) and clinical management were analyzed. Results: We included 159 consecutive COVID-19 critical patients. The median (IQR) age was 66(57-72);101(63.5%) were male. A total of 126 (79.2%) patients received hospital discharge, ICU-mortality rate was 18.9%(30 deaths). The median (IQR) ICU length of stay was 12 days (6-20) and in-hospital stay was 21(13-35), and no significant differences were found in ICU and in-hospital length of stay between survivors and non-survivors. At admission to the ICU total SOFA score was 4(3-7). In univariate analysis, increased age, higher admission SOFA score, acute kidney injury and acute neurologic disfunction at admission were significantly associated with increased hazard of mortality. The need for mechanical ventilation were associated with higher risk of ICU and in-hospital mortality. Previous comorbidities (hypertension, diabetes, obesity, heart failure, COPD, renal, hepatic, oncologic or immunosuppression) or the FS were not significantly associated with in-hospital mortality. None of the COVID-19 pharmacologic treatments (remdesivir, steroids and tocilizumab) were significantly associated with in-hospital mortality. In a multivariable analysis with in-hospital death as the dependent variable, a 10 year increase in age was associated with a mortality OR of 2.9 (95 CI:1.5-5.5)( p = 0.002) and the development of shock during ICU stay was associated with a mortality OR of 8.8 (95 CI:1.5 to 53.3). Conclusions: In this cohort, only age and the development of shock during ICU stay were independently associated with higher risk of inhospital death.