Increased mortality in patients with severe SARS-CoV-2 infection admitted within seven days of disease onset
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ORIGINAL
Increased mortality in patients with severe SARS‑CoV‑2 infection admitted within seven days of disease onset Elie Azoulay1,2* , Muriel Fartoukh2,3, Michael Darmon1,2, Guillaume Géri2,4, Guillaume Voiriot2,3, Thibault Dupont1,2, Lara Zafrani1,2, Lola Girodias2,4, Vincent Labbé2,3, Martin Dres2,5, Alexandra Beurton2,5, Antoine Vieillard‑Baron2,4 and Alexandre Demoule2,5 © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Abstract Purpose: Coronavirus disease 2019 (COVID-19) is creating an unprecedented healthcare crisis. Understanding the determinants of mortality is crucial to optimise intensive care unit (ICU) resource use and to identify targets for improving survival. Methods: In a multicentre retrospective study, we included 379 COVID-19 patients admitted to four ICUs between 20 February and 24 April 2020 and categorised according to time from disease onset to ICU admission. A Cox propor‑ tional-hazards model identified factors associated with 28-day mortality. Results: Median age was 66 years (53–68) and 292 (77%) were men. The main comorbidities included obesity and overweight (67%), hypertension (49.6%) and diabetes (30.1%). Median time from disease onset (i.e., viral symptoms) to ICU admission was 8 (6–11) days (missing for three); 161 (42.5%) patients were admitted within a week of disease onset, 173 (45.6%) between 8 and 14 days, and 42 (11.1%) > 14 days after disease onset; day 28 mortality was 26.4% (22–31) and decreased as time from disease onset to ICU admission increased, from 37 to 21% and 12%, respectively. Patients admitted within the first week had higher SOFA scores, more often had thrombocytopenia or acute kidney injury, had more limited radiographic involvement, and had significantly higher blood IL-6 levels. Age, COPD, immu‑ nocompromised status, time from disease onset, troponin concentration, and acute kidney injury were independently associated with mortality. Conclusion: The excess mortality in patients admitted within a week of disease onset reflected greater non-respir‑ atory severity. Therapeutic interventions against SARS-CoV-2 might impact different clinical endpoints according to time since disease onset. Keywords: Coronavirus, Viral infection, Acute kidney injury, Acute respiratory distress syndrome
*Correspondence: [email protected] 1 Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, APHP, Paris, France Full author information is available at the end of the article
Introduction The COVID-19 pandemic has created an unprecedented healthcare crisis. With more than four million confirmed cases worldwide and nearly 280,000 deaths during the first 4 months of 2020, the number of patients with severe forms requiring critical care has overwhelmed intensive care units (ICUs) in many countries. Respiratory failure is the main source of morbidity and mortality in severe cases. The causative agent of COVID-19, SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus 2) [1, 2], is the third documented spillover of an animal coronavirus
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