Critical Care (Jul 2020)

Clinical course and predictors of 60-day mortality in 239 critically ill patients with COVID-19: a multicenter retrospective study from Wuhan, China

  • Jiqian Xu,
  • Xiaobo Yang,
  • Luyu Yang,
  • Xiaojing Zou,
  • Yaxin Wang,
  • Yongran Wu,
  • Ting Zhou,
  • Yin Yuan,
  • Hong Qi,
  • Shouzhi Fu,
  • Hong Liu,
  • Jia’an Xia,
  • Zhengqin Xu,
  • Yuan Yu,
  • Ruiting Li,
  • Yaqi Ouyang,
  • Rui Wang,
  • Lehao Ren,
  • Yingying Hu,
  • Dan Xu,
  • Xin Zhao,
  • Shiying Yuan,
  • Dingyu Zhang,
  • You Shang

DOI
https://doi.org/10.1186/s13054-020-03098-9
Journal volume & issue
Vol. 24, no. 1
pp. 1 – 11

Abstract

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Abstract Background The global numbers of confirmed cases and deceased critically ill patients with COVID-19 are increasing. However, the clinical course, and the 60-day mortality and its predictors in critically ill patients have not been fully elucidated. The aim of this study is to identify the clinical course, and 60-day mortality and its predictors in critically ill patients with COVID-19. Methods Critically ill adult patients admitted to intensive care units (ICUs) from 3 hospitals in Wuhan, China, were included. Data on demographic information, preexisting comorbidities, laboratory findings at ICU admission, treatments, clinical outcomes, and results of SARS-CoV-2 RNA tests and of serum SARS-CoV-2 IgM were collected including the duration between symptom onset and negative conversion of SARS-CoV-2 RNA. Results Of 1748 patients with COVID-19, 239 (13.7%) critically ill patients were included. Complications included acute respiratory distress syndrome (ARDS) in 164 (68.6%) patients, coagulopathy in 150 (62.7%) patients, acute cardiac injury in 103 (43.1%) patients, and acute kidney injury (AKI) in 119 (49.8%) patients, which occurred 15.5 days, 17 days, 18.5 days, and 19 days after the symptom onset, respectively. The median duration of the negative conversion of SARS-CoV-2 RNA was 30 (range 6–81) days in 49 critically ill survivors that were identified. A total of 147 (61.5%) patients deceased by 60 days after ICU admission. The median duration between ICU admission and decease was 12 (range 3–36). Cox proportional-hazards regression analysis revealed that age older than 65 years, thrombocytopenia at ICU admission, ARDS, and AKI independently predicted the 60-day mortality. Conclusions Severe complications are common and the 60-day mortality of critically ill patients with COVID-19 is considerably high. The duration of the negative conversion of SARS-CoV-2 RNA and its association with the severity of critically ill patients with COVID-19 should be seriously considered and further studied.

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