Increased mortality in patients with severe SARS-CoV-2 infection admitted within seven days of disease onset.

Abstract

PURPOSE:

Coronavirus disease 2019 (COVID-19) is creating an unprecedented healthcare crisis. Understanding the determinants of mortality is crucial to optimise intensive care unit (ICU) resource use and to identify targets for improving survival.

METHODS:

In a multicentre retrospective study, we included 379 COVID-19 patients admitted to four ICUs between 20 February and 24 April 2020 and categorised according to time from disease onset to ICU admission. A Cox proportional-hazards model identified factors associated with 28-day mortality.

RESULTS:

Median age was 66 years (53-68) and 292 (77%) were men. The main comorbidities included obesity and overweight (67%), hypertension (49.6%) and diabetes (30.1%). Median time from disease onset (i.e., viral symptoms) to ICU admission was 8 (6-11) days (missing for three); 161 (42.5%) patients were admitted within a week of disease onset, 173 (45.6%) between 8 and 14 days, and 42 (11.1%) > 14 days after disease onset; day 28 mortality was 26.4% (22-31) and decreased as time from disease onset to ICU admission increased, from 37 to 21% and 12%, respectively. Patients admitted within the first week had higher SOFA scores, more often had thrombocytopenia or acute kidney injury, had more limited radiographic involvement, and had significantly higher blood IL-6 levels. Age, COPD, immunocompromised status, time from disease onset, troponin concentration, and acute kidney injury were independently associated with mortality.

CONCLUSION:

The excess mortality in patients admitted within a week of disease onset reflected greater non-respiratory severity. Therapeutic interventions against SARS-CoV-2 might impact different clinical endpoints according to time since disease onset.

• Authors: Elie Azoulay, Muriel Fartoukh, Michael Darmon, Guillaume Géri, Guillaume Voiriot, Thibault Dupont, Lara Zafrani, Lola Girodias, Vincent Labbé, Martin Dres, Alexandra Beurton, Antoine Vieillard-Baron, Alexandre Demoule
• Journal: Intensive care medicine (Intensive Care Med) Vol. 46 Issue 9 Pg. 1714-1722 (Sep 2020) ISSN: 1432-1238 [Electronic] United States
• PMID: 32780165 (Publication Type: Journal Article, Observational Study)

Chemical References

• Interleukin-6
• Troponin

Topics

• Age Factors
• Betacoronavirus
• COVID-19
• Comorbidity
• Coronavirus Infections (mortality)
• Female
• France (epidemiology)
• Humans
• Intensive Care Units (statistics & numerical data)
• Interleukin-6 (blood)
• Male
• Middle Aged
• Organ Dysfunction Scores
• Pandemics
• Pneumonia, Viral (mortality)
• Proportional Hazards Models
• Real-Time Polymerase Chain Reaction
• Retrospective Studies
• Risk Factors
• SARS-CoV-2
• Time Factors
• Time-to-Treatment
• Troponin (blood)