The University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) Recently reviewed two important study results published by JAMA Internal Medicine as well as the results from a Chinese observational study. In the American study, several factors were associated with death in COVID-19 patients, while a study in Italy also reveals the dangers of age and comorbidity as well as ICU intensity of use as a risk factor for death associated with COVID-19. The clinical features of 100 SARS-CoV-19 patients who passed in China were also summarized. A number of high-level takeaways are possible, but the most urgent is that elderly males with comorbidity face significantly higher risks for death from COVID-19. Other surprising take ways: COVID-19 death could be associated with how many ICU beds were actually in the hospital. Larger hospitals had lower death rates than smaller ones with less pre-pandemic ICU beds. Across the board, elderly males with one or more problems are at a far greater risk for COVID-19 death. The TrialSite offers a brief breakdown for the network.
Enhanced Risk Factors for COVID-19 Death
In one study, one of the largest multicenter cohort analysis of critically ill COVID-19 patients across the United States revealed that 2,215 adults admitted to intensive care units (ICUs) across 65 hospitals during the period March 4 to April 4, 784 (35%) died within 28 days of hospitalization. The researchers identified a number of risk factors such as body mass index, age, coronary artery disease, active cancer, low oxygen levels, etc. Death rates, after adjusting for different risk factors, ranges from 6% to 80%. Of interest, the number of pre-pandemic ICU beds in the specific hospital was strongly linked to the death rate. Put simply, if the hospital had fewer than 50 ICU beds, a patient had a more than three-fold higher risk of death than those admitted to hospitals with at least 100 ICU beds.
The researchers found a wide variety of medications administered, some of them not approved or unproven such as hydroxychloroquine, azithromycin, and clot-preventing anticoagulants while methods such as prone positioning became increasingly in favor.
This research team, led by David Leaf, MD, MMSc, Brigham and Women’s Hospital in Boston, reported in an associated press release that the study revealed “critically ill patients with COVID-19 have a greater than 1-in-3 chance of short-term death. We also found that treatment and outcomes varied considerably between hospitals.”
Italian Retrospective Study
In a retrospective cohort study in Lombardy Italy, the epicenter of the pandemic in Europe, the researchers found that of 1,715 critically ill COVID-19 patients admitted to regional hospitals, 915 (53%) died of their infections. At ICU admission, 87.3% of the patients needed invasive mechanical ventilation. Moreover, an additional 350 needed extra oxygen delivered via helmet or mask. A number of risk factors for death were identified, ranging from advanced age, male sex, and need for oxygen to obstructive pulmonary disease, high cholesterol, and type 2 diabetes. 60.5% of the patients had one or more underlying conditions, the most common being high blood pressure, abnormal cholesterol levels, and heart disease.
The research authors shared that crowded ICUs with many ill with COVID-19 compromised healthcare workers’ ability to care for the patients. The authors concluded: “These sobering statistics highlight the long ICU stays, prolonged need for respiratory support, and high mortality of COVID-19 in critically ill patients,” the authors wrote. “Until effective and specific therapies are available, supportive care is the mainstay of treatment for critically ill patients. Providing this care at a high-quality level for the high volume of patients to treat is a challenge for all health care systems.”
Underlying Illness & Advanced Age in China
Chinese researchers found that of the 100 patients who died due to COVID-19 from January 23 to March 10, 76% had at least one underlying condition such as high blood pressure (41%), diabetes (29%), coronary heart disease (27%), respiratory condition (23%), and cerebrovascular disease (12%). The three most common causes of death were cardiovascular disease and diabetes, with multi-organ failure as the most common direct cause. 64% of those who died were male at an average age of 70.7 years; 84% of the patients were 60 plus.
Call to Action: Visit the University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP) to learn more.