LAUSR

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: COVID-19 is a major public health emergency with increasing mortality since the first case in December 2019. COVID-19 has multifaceted presentation and only about 15-20% required hospitalizations and a quarter of those required management in an intensive care unit (ICU). Herein, we reviewed the demographics, clinical outcomes, and identified the potential prognostic indicators in patients with COVID-19 who were admitted to our ICU. METHODS: A retrospective cohort study was conducted on patients ≥ 18 years old with confirmed COVID-19, who were admitted to our ICU between 03/17/2020 and 05/14/2020. Demographic, clinical, and laboratory data were reviewed and retrieved. Data was expressed as counts and percentages. T-test and chi-square (χ) were used for continuous and categorical variables respectively. Univariate analysis was also performed to identify the prognostic indicators associated with mortality. GraphPad PRISM was used for data analysis. RESULTS: Seventy-five patients were identified during the study period with an average age of 60.8 (ranged from 19-89), of which males were 99 (71%) and females were 41 (29%). Majority were Hispanic (45%) and African Americans (34%). The average body mass index was 30.6. Hypertension (47.9%) and chronic kidney disease (47.1%) were the most common comorbidities. Mechanical ventilation was required in 99 (70.7%) of the patients. Of those 99, 75 (76%) expired. There was no statistically significant difference between the survival and expired groups in term of age, gender, ethnicities and number of comorbidities. Need of mechanical ventilation (MV) and renal replacement therapy (RRT) were significantly associated with mortality (p<0.0001 for both parameters). Interestingly, use of therapeutic anticoagulation was associated with decrease risk of mortality (p-value 0.03865). When looking into the laboratory parameters, higher blood urea nitrogen (BUN) on Day 5 (p-value 0.0067), initial LDH (p<0.0001), initial CRP (p-value 0.0062), white blood cell counts (WBC) (p<0.0001), and high absolute neutrophil counts (ANC) (p-value 0.0002) were statistically associated with increased risk of mortality. SOFA scores did not predict mortality in these patients (p-value 0.9243) CONCLUSIONS: This retrospective cohort study on patients with COVID-19 who required ICU showed that need for Mechanical Ventilation and Renal Replacement Therapy were significantly associated with mortality. Surprisingly, use of therapeutic anticoagulation decreased the risk of mortality and initial LDH and CRP were the two inflammatory markers that may help predict mortality. This interesting finding need to be corroborated in a larger study. CLINICAL IMPLICATIONS: This study was done using the data during the initial two months of first wave of COVID-19 in the United States and the data represents our observations at that time. Several studies have been done on the use of Anticoagulation in COVID-19 patients thereafter, however there is no universally accepted protocol. This study helped us identify the differences in the outcome between first and second use with aggressive use of anticoagulation, Remdesivir, and dexamethasone during the second wave. DISCLOSURES: No relevant relationships by Sharath Bellary, source=Web Response No relevant relationships by Kok Hoe Chan, source=Web Response No relevant relationships by Joanna Crincoli, source=Web Response No relevant relationships by Claudia Komer, source=Web Response No relevant relationships by Sudha Lagudu, source=Web Response No relevant relationships by Richard Miller, source=Web Response No relevant relationships by Meenakshi Sindhuri Nali, source=Web Response No relevant relationships by Amy Paige, source=Web Response No relevant relationships by Rutwik Patel, source=Web Response No relevant relationships by Laxminarayan Prabhakar, source=Web Response No relevant relationships by Amr Ramahi, source=Web Response No relevant relationships by Divya Mounisha Thimmareddygari, source=Web Response