Department of Internal Medicine, Intensive Care Unit, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
Department of Public Health, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
Turk J Med Sci. 2021 Aug 30;51(4):1665-1674. doi: 10.3906/sag-2101-89.
BACKGROUND/AIM: Coronavirus disease 2019 (COVID-19) is a disease with a high rate of progression to critical illness. However, the predictors of mortality in critically ill patients admitted to the intensive care unit (ICU) are not yet well understood. In this study, we aimed to investigate the risk factors associated with ICU mortality in our hospital.
In this single-centered retrospective study, we enrolled 86 critically ill adult patients with COVID-19 admitted to ICU of Dokuz Eylül University Hospital (İzmir, Turkey) between 18 March 2020 and 31 October 2020. Data on demographic information, preexisting comorbidities, treatments, the laboratory findings at ICU admission, and clinical outcomes were collected. The chest computerized tomography (CT) of the patients were evaluated specifically for COVID-19 and CT score was calculated. Data of the survivors and nonsurvivors were compared with survival analysis to identify risk factors of mortality in the ICU.
The mean age of the patients was 71.1 ± 14.1 years. The patients were predominantly male. The most common comorbidity in patients was hypertension. ICU mortality was 62.8%. Being over 60 years old, CT score > 15, acute physiology and chronic health evaluation (APACHE) II score ≥ 15, having dementia, treatment without favipiravir, base excess in blood gas analysis ≤ –2.0, WBC > 10,000/mm3, D-dimer > 1.6 μg/mL, troponin > 24 ng/L, Na ≥ 145 mmol/L were considered to link with ICU mortality according to Kaplan–Meier curves (log-rank test, p < 0.05). The APACHE II score (HR: 1.055, 95% CI: 1.021–1.090) and chest CT score (HR: 2.411, 95% CI:1.193–4.875) were associated with ICU mortality in the cox proportional-hazard regression model adjusted for age, dementia, favipiravir treatment and troponin. Howewer, no difference was found between survivors and nonsurvivors in terms of intubation timing.
COVID-19 patients have a high ICU admission and mortality rate. Studies in the ICU are also crucial in this respect. In our study, we investigated the ICU mortality risk factors of COVID-19 patients. We determined a predictive mortality model consisting of APACHE II score and chest CT score. It was thought that this feasible and practical model would assist in making clinical decisions.
背景/目的：2019 年冠状病毒病（COVID-19）是一种进展为危重症的发生率很高的疾病。然而，重症监护病房（ICU）收治的危重症患者的死亡预测因素尚不清楚。在本研究中，我们旨在调查我院 ICU 死亡率相关的危险因素。
这是一项单中心回顾性研究，共纳入了 2020 年 3 月 18 日至 10 月 31 日期间在多乌泽尔大学医院（土耳其伊兹密尔）ICU 收治的 86 例 COVID-19 成年危重症患者。收集了人口统计学信息、合并症、治疗、入 ICU 时的实验室检查结果和临床结局等数据。专门对患者的胸部计算机断层扫描（CT）进行了 COVID-19 评估，并计算了 CT 评分。对幸存者和非幸存者的数据进行生存分析，以确定 ICU 死亡率的危险因素。
患者的平均年龄为 71.1±14.1 岁。患者主要为男性。患者最常见的合并症是高血压。ICU 死亡率为 62.8%。年龄大于 60 岁、CT 评分>15、急性生理学和慢性健康评估（APACHE）Ⅱ评分≥15、有痴呆、未使用法匹拉韦、血气分析的碱剩余≤-2.0、白细胞计数>10,000/mm3、D-二聚体>1.6μg/mL、肌钙蛋白>24ng/L、Na≥145mmol/L 与 ICU 死亡率相关，这是根据 Kaplan-Meier 曲线（对数秩检验，p<0.05）得出的结论。APACHE Ⅱ评分（HR：1.055，95%CI：1.021-1.090）和胸部 CT 评分（HR：2.411，95%CI：1.193-4.875）与 Cox 比例风险回归模型中调整年龄、痴呆、法匹拉韦治疗和肌钙蛋白后的 ICU 死亡率相关。然而，在插管时机方面，幸存者和非幸存者之间没有差异。
COVID-19 患者 ICU 入住率和死亡率均较高。在 ICU 进行研究也非常重要。在本研究中，我们调查了 COVID-19 患者的 ICU 死亡率危险因素。我们确定了一个由 APACHE Ⅱ评分和胸部 CT 评分组成的预测死亡率模型。该模型具有可行性和实用性，可用于临床决策。
