Case series offers insight on critically ill patients with COVID-19
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A research letter published in JAMA has described some of the initial characteristics and outcomes of critically ill patients with COVID-19.
The small case series involved 21 patients with confirmed SARS-CoV-2 infection, the novel coronavirus that causes COVID-19, who were admitted to the ICU at Evergreen Hospital in Kirkland, Washington, from Feb. 20 to March 5. The mean age of patients was 70 years and approximately half were men. The most common comorbidities, which were present in 86% of patients, included chronic kidney disease and congestive heart failure.
Symptom onset occurred an average of 3.5 days before hospital presentation, with most patients experiencing shortness of breath (76%), fever (52%) and cough (48%). Eighty-one percent were admitted to the ICU less than 24 hours after admission.
In terms of imaging, the researchers found that 95% of patients had an abnormal chest radiograph at admission, with bilateral reticular opacities (52%) and ground-glass opacities (48%) as the most common initial findings. The proportion of patients with bilateral reticular nodular opacities and ground-glass opacities increased to 86% and 67%, respectively, by 72 hours after admission.
Results showed that the mean white blood cell count was 9,365 µL at admission, approximately two-thirds had a white blood cell count in the normal range and approximately two-thirds had an absolute lymphocyte count less than 1,000 cells/µL.
Thirty-eight percent of patients also had abnormal liver function tests at admission.
Initiation of mechanical ventilation was common, occurring in 71% of patients. Of those requiring mechanical ventilation, all developed acute respiratory distress syndrome within 72 hours. Sixty-seven percent of patients also received vasopressors during the illness, although most patients did not present with shock.
One-third of patients also developed cardiomyopathy.
“It is unclear whether the high rate of cardiomyopathy in this case series reflects a direct cardiac complication of SARS-CoV-2 infection or resulted from overwhelming critical illness. Others have described cardiomyopathy in COVID-19, and further research may better characterize this risk,” the researchers wrote.
As of Tuesday, 67% of patients had died, 24% remained critically ill and 9.5% were discharged from the ICU.
The researchers noted that the study is limited by the small number of patients and its single-center design, as well as the study population, which included older residents of skilled nursing facilities. Consequently, these results may not capture the broader experience of other critically ill patients with COVID-19.
“However, this study provides some initial experiences regarding the characteristics of COVID-19 in patients with critical illness in the U.S. and emphasizes the need to limit exposure of nursing home residents to SARS-CoV-2,” they wrote. – by Melissa Foster
Disclosures: The authors report no relevant financial disclosures.