ABSTRACT
BACKGROUND: The characteristics, outcomes, and risk factors for in-hospital death of critically ill intensive care unit (ICU) patients with coronavirus disease-2019 (COVID-19) have been described in patients from Europe, North America and China, but there are few data from COVID-19 patients in Middle Eastern countries. The aim of this study was to investigate the characteristics, outcomes, and risk factors for in-hospital death of critically ill patients with COVID-19 pneumonia admitted to the ICUs of a University Hospital in Egypt. METHODS: Retrospective analysis of patients with COVID-19 pneumonia admitted between April 28 and July 29, 2020 to two ICUs dedicated to the isolation and treatment of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in Cairo University Hospitals. Diagnosis was confirmed in all patients using real-time reverse transcription polymerase chain reaction on respiratory samples and radiologic evidence of pneumonia. RESULTS: Of the 177 patients admitted to the ICUs during the study period, 160 patients had COVID-19 pneumonia and were included in the analysis (mean age: 60 ± 14 years, 67.5% males); 23% of patients had no known comorbidities. The overall ICU and hospital mortality rates were both 24.4%. The ICU and hospital lengths of stay were 7 (25-75% interquartile range: 4-10) and 10 (25-75% interquartile range: 7-14) days, respectively. In a multivariable analysis with in-hospital death as the dependent variable, ischemic heart disease, history of smoking, and secondary bacterial pneumonia were independently associated with a higher risk of in-hospital death, whereas greater PaO2/FiO2 ratio on admission to the ICU was associated with a lower risk. CONCLUSION: In this cohort of critically ill patients with COVID-19 pneumonia, ischemic heart disease, history of smoking, and secondary bacterial pneumonia were independently associated with a higher risk of in-hospital death.
Subject(s)
COVID-19 , Pneumonia, Bacterial , Aged , Egypt/epidemiology , Female , Hospital Mortality , Hospitals, University , Humans , Intensive Care Units , Male , Middle Aged , Retrospective Studies , Risk Factors , SARS-CoV-2ABSTRACT
COVID-19 has been declared a global pandemic by the World Health Organization and is responsible for hundreds of thousands of deaths worldwide. COVID-19 is caused by SARS-CoV-2, and common clinical symptoms include fever, cough, sore throat, headache, and fatigue. Myocardial injury is relatively common in patients with COVID-19, accounting for 7%-23% of cases, and is associated with a higher rate of morbidity and mortality. There is a discrepancy in the literature about myocarditis as the etiology of myocardial injury in patients with COVID-19; although many anecdotal reports of myocarditis have been noted, there are only a handful of case reports in the literature about myocarditis related to COVID-19. In this review we summarize the most up to date literature around the association between COVID-19 and myocarditis and provide clinicians a practical framework about the clinical manifestations, diagnostic tools, and treatment options currently available. Importantly, this review will heighten suspicion for myocarditis as an etiology of myocardial injury in COVID-19 patients, therefore improving clinical outcomes and encouraging shared clinical decision-making. This will also open the door for further research to build around this review. Emergent treatment options for COVID-19 are in clinical trials and might be of benefit to COVID-19 patients with myocarditis in addition to current guideline-based recommendations.
La COVID-19 a été déclarée pandémie mondiale par l'Organisation Mondiale de la Santé et elle est responsable de centaines de milliers de décès dans le monde. La COVID-19 est causée par le SARS-CoV-2, et les symptômes cliniques courants sont la fièvre, la toux, le mal de gorge, les maux de tête et la fatigue. Les lésions myocardiques sont relativement fréquentes chez les patients atteints de la COVID-19, représentant 7 à 23 % des cas, et sont associées à un taux de morbidité et de mortalité plus élevé. Il existe des divergences dans la littérature décrivant la myocardite en tant qu'étiologie de lésions myocardiques chez les patients atteints de la COVID-19; bien que de nombreux rapports anecdotiques de myocardite aient été rapportés, il n'y a qu'un nombre limité de rapports de cas dans la littérature concernant des myocardites liées à la COVID-19. Dans cette revue de littérature, nous résumons la bibliographie la plus récente sur l'association entre COVID-19 et myocardite et fournissons aux cliniciens un cadre pratique sur les signes cliniques, les outils de diagnostic et les options de traitement actuellement disponibles. Il est important de noter que cette revue augmentera la suspicion de myocardite comme étiologie de lésions myocardiques chez les patients atteints de la COVID-19, améliorant ainsi le pronostic clinique et encourageant une prise de décision clinique partagée. Cela ouvrira également la voie à d'autres recherches qui pourront s'appuyer sur cette étude. De nouvelles options de traitement de la COVID-19 sont en cours d'essais cliniques et pourraient être bénéfiques aux patients atteints de la COVID-19 qui présentent une myocardite, tout en étant considérées pour les recommandations actuelles basées sur les lignes directrices.