Massachusetts Chapter of the American College of Surgeons

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Multi-System Outcomes and Predictors of Mortality in Critically Ill Patients with COVID-19: Demographics, and Disease Acuity matter more than Comorbidities or Treatment Modalities
Osaid Alser, MD, MSc(Oxon)1, Ava Mokhtari, MSc1, Leon Naar, MD1, Kimberly Langeveld, BSc1, Kerry A. Breen, BSc1, Mohamad El Moheb, MD1, Carolijn Kapoen, BSc1, Apostolos Gaitanidis, MD1, Mathias A. Christensen BSc1, Lydia R. Maurer, MD1, Hassan Mashbari, MD1, Brittany Bankhead-Kendall, MD, MS1, Jonathan Parks, MD1, Jason Fawley, MD1, Noelle Saillant, MD1, April Mendoza, MD, MPH1, Charudutt Paranjape, MD1, Peter Fagenholz, MD1, David King, MD1, Jarone Lee, MD1, Maha R. Farhat, MD, MSc2, George C. Velmahos, MD, PhD1, Haytham M.A. Kaafarani, MD, MPH1
1Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA, 2Division of Pulmonary Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Background: We sought to describe patient characteristics, multi-system outcomes, and predictors of mortality of the critically-ill COVID-19 patients in the largest hospital in Massachusetts.
Methods: This is a cohort study of all patients admitted to the intensive care unit (ICU) with reverse-transcriptase–polymerase-chain-reaction-confirmed SARS-CoV-2 infection between March 14th, 2020 and April 28th, 2020. Multi-system outcomes were evaluated. Multivariable logistic regression analyses adjusting for available confounders were performed to identify predictors of mortality.
Results: A total of 235 patients were included. The median Sequential Organ Failure Assessment (SOFA) score was 5 (3, 8) and the median PaO2/FiO2 was 208 (146, 300) with 88.5% of patients meeting criteria for acute respiratory distress syndrome. The median (IQR) follow-up was 92 (86, 99) days and the median ICU length of stay was 16 (8, 25) days; 62.1% of patients were proned, and 49.8% required neuromuscular blockade. The most common complications were shock (88.9%), acute kidney injury (69.8%), secondary bacterial pneumonia (70.6%), and pressure ulcers (51.1%) (Figure 1). As of July 8th, 2020, no patient remained on mechanical ventilation, 74.5% were discharged alive, and 24.7% died. Age [OR=1.17, 95% CI 1.06-1.17], male sex [OR=7.40, 95% CI 2.03-26.93], Black/African American race [OR=0.02, 95% CI 0.00-0.24], SOFA score [OR=1.42, 95% CI 1.17-1.72], and elevated creatinine kinase (?1000 U/L) [OR=7.96, 95% CI 1.45-43.71] independently predicted mortality, but not comorbidities or hydroxychloroquine treatment.
Conclusion: We present here the outcomes of critically-ill patients with COVID-19. Age, sex, race, and acuity of disease predicted mortality rather than comorbidities or treatment modality.


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