N. Sinem GEZER, Begüm ERGAN, A.Necati GÖKMEN, Oya Özlem EREN KUTSOYLU, Yusuf SAVRAN, Vecihe BAYRAK, Nurcan ŞENTÜRK DURUKAN, Ferhan DEMİRER AYDEMİR

Risk factors associated with mortality in ıntensive care COVID-19 patients: the importance of chest CT score and intubation timing as risk factors

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. Materials and methods: 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. Results: 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. Conclusions: 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.Key words: COVID-19, ICU mortality, CT score, intubation timing, APACHE II

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1. Huang C, Wang Y, Li X, Ren L, Zhao J et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506. doi: 10.1016/S0140- 6736(20)30183-5.
2. Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA - Journal of the American Medical Association 2020; 323 (16): 1545-1546. doi:10.1001/jama.2020.4031
3. Chen N, Zhou M, Dong X, Qou J, Gonget F et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223): 507-513. doi:10.1016/S0140- 6736(20)30211-7
4. Paranjpe I, Russak A, De Freitas J, Lala A, Miotto R et al. Clinical characteristics of hospitalized Covid-19 patients in New York City. medRxiv Preprint for Health Sciiences 2020. doi:10.1101/2020.04.19.20062117
5. Zhang Q, Shen J, Chen L, Li S, Zhang W et al. Timing of invasive mechanic ventilation in critically ill patients with coronavirus disease 2019. The Journal of Trauma and Acute Care Surgery 2020; 89 (6):1092-1098. doi:10.1097/TA.0000000000002939
6. Francone M, Iafrate F, Masci GM, Coco S, Cilia F et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. European Radiology 2020; 30 (12): 6808-6817. doi:10.1007/s00330-020-07033-y
7. Salaffi F, Carotti M, Tardella M, Borgheresi A, Agostini A et al. The role of a chest computed tomography severity score in coronavirus disease 2019 pneumonia. Medicine (Baltimore) 2020; 99 (42): e22433. doi:10.1097/MD.0000000000022433
8. Hashemi-madani N, Emami Z, Janani L, Khamseh ME. Typical chest CT features can determine the severity of COVID-19: a systematic review and meta-analysis of the observational studies. Clinical Imaging 2021; 74: 67-75. doi:10.1016/j. clinimag.2020.12.037
9. Xiao N, Cooper JG, Godbe JM, Bechel M, Scott M et al. Chest radiograph at admission predicts early intubation among inpatient COVID-19 patients. European Radiology 2020. doi:10.1007/s00330-020-07354-y
10. Lanza E, Muglia R, Bolengo I, Santonocito O, Lisi C et al. Quantitative chest CT analysis in COVID-19 to predict the need for oxygenation support and intubation. European Radiology 2020; 30 (12). doi:10.1007/s00330-020-07013-2
11. Yang W, Sirajuddin A, Zhang X, Liu G, Teng Z et al. The role of imaging in 2019 novel coronavirus pneumonia (COVID-19). European Radiology 2020; 30 (9): 4874-4882. doi:10.1007/ s00330-020-06827-4
12. Xu X, Yu C, Qu J, Zhang L, Jiang S et al. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2. European Journal of Nuclear Medicine and Molecular Imaging 2020; 47 (5): 1275-1280. doi:10.1007/s00259-020-04735-9
13. Zheng Q, Lu Y, Lure F, Jaeger S, Lu P. Clinical and radiological features of novel coronavirus pneumonia. Journal of X-Ray Science and Technology 2020; 28 (3): 391-404. doi:10.3233/ XST-200687
14. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): a systematic review of ımaging findings in 919 patients. American Journal of Roentgenology 2020; 215 (1): 87-93. doi:10.2214/AJR.20.23034
15. Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. doi: 10.1007/s00330-020-06801-0
16. Simpson S, Kay F, Abbara S, Bhalla S, Chung J et al. Radiological society of North America expert consensus statement on reporting chest CT findings related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA - Secondary Publication. Journal of Thoracic Imaging 2020; 35 (4): 219-227. doi:10.1097/ RTI.0000000000000524
17. Chang Y, Yu C, Chang S, Galvin J, Liu H et al. Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: evaluation with thin-section CT. Radiology 2005; 236 (3): 1067-1075. doi:10.1148/radiol.2363040958
18. Ñamendys-Silva S, Alvarado-Ávila P, Domínguez-Cherit G, Rivero-Sigarroa E, Sánchez-Hurtado L et al. Outcomes of patients with COVID-19 in the intensive care unit in Mexico: a multicenter observational study. Heart Lung 2020. doi:10.1016/j.hrtlng.2020.10.013
19. Kocayiğit H, Özmen Süner K, Tomak Y, Demir G, Kocayiğit İ et al. Characteristics and outcomes of critically ill patients with Covid-19 in Sakarya, Turkey: a single center cohort study. Turkısh Journal of Medical Science 2020. doi:10.3906/sag2005-57
20. Alharthy A, Aletreby W, Faqihi F, Ballhamar A, Alaklobi F et al. Clinical characteristics and predictors of 28-day mortality in 352 critically ill patients with COVID-19: a retrospective study. Journal of Epidemiology and Global Health 2020; 0 (0): 0-0. doi:10.2991/jegh.k.200928.001
21. Wang Y, Lu X, Li Y, Chen H, Su N et al. Clinical course and outcomes of 344 intensive care patients with COVID-19. American Journal of Respiratory Critical Care Medicne 2020; 201 (11): 1430-1434. doi:10.1164/rccm.202003-0736LE
22. Canevelli M, Palmieri L, Raparelli V, Lo Noce C, Colaizzo E et al. Prevalence and clinical correlates of dementia among COVID-19-related deaths in Italy. Alzheimer’s & Dementia Diagnosis: Assessment Disease Monitoring 2020; 12 (1). doi: 10.1002/dad2.12114
23. Yamamura H, Matsuura H, Nakagawa J, Fukuoka H, Domi H et al. Effect of favipiravir and an anti-inflammatory strategy for COVID-19. Critical Care 2020; 24 (1). doi:10.1186/s13054- 020-03137-5
24. Şimşek Yavuz S, Ünal S. Antiviral treatment of covid-19. Turkish Journal of Medical Sciences 2020; 50 (SI-1): 611-619. doi:10.3906/sag-2004-145
25. Lee YH, Choi K-J, Choi SH, Lee S, Kim K et al. Clinical significance of timing of ıntubation in critically ill patients with COVID-19: a multi-center retrospective study. Journal of Clinical Medicine 2020; 9 (9). doi:10.3390/jcm9092847
26. Hernandez-Romieu AC, Adelman MW, Hockstein MA, Robichaux C, Edwards J et al. Timing of intubation and mortality among critically ill Coronavirus disease 2019 patients: a single-center cohort study. Critical Care Medicine 2020; 48 (11): e1045-e1053. doi: 10.1097/ccm.0000000000004600
27. Li K, Fang Y, Li W, Pan C, Quin P et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). European Radiology 2020; 30 (8): 4407- 4416. doi:10.1007/s00330-020-06817-6
28. Zhang J, Meng G, Li W, Shi B, Dong H et al. Relationship of chest CT score with clinical characteristics of 108 patients hospitalized with COVID-19 in Wuhan, China. Respiratory Research 2020. doi: 10.1186/s12931-020-01440-x
29. Li K, Wu J, Wu F, Guo D, Chen L et al. The clinical and chest CT features associated with severe and critical COVID-19 pneumonia. Investigative Radiology 2020; 55 (6): 327-331. doi:10.1097/RLI.0000000000000672
30. Feng Z, Yu Q, Yao S, Luo L, Zhou W et al. Early prediction of disease progression in COVID-19 pneumonia patients with chest CT and clinical characteristics. Nature Communications 2020; 11 (1). doi:10.1038/s41467-020-18786-x
31. Colombi D, Bodini F, Petrini M, Maffi G, Morelli N et al. Wellaerated lung on admitting chest CT to predict adverse outcome in COVID-19 pneumonia. Radiology 2020; 296 (2): 86-96. doi: 10.1148/radiol.2020201433
32. Zhou S, Chen C, Hu Y, Lv W, Ai T et al. Chest CT imaging features and severity scores as biomarkers for prognostic prediction in patients with COVID-19. Annals of Translational Medicine 2020; 8 (21): 1449-1449. doi:10.21037/atm-20-3421