Clinical Characteristics and Risk Factors for Mortality of Hospitalized Patients with Severe COVID-19 in Intensive Care Unit: A Retrospective Cohort Study

Objective: To describe the clinical characteristics, complications, and risk factors for mortality of hospitalized patients with severe coronavirus disease 2019 (COVID-19) during intensive care therapy.

Methods: This single-center retrospective cohort study included 149 patients with severe COVID-19 admitted to an intensive care unit (ICU) from April 2020 to August 2021. Demographic characteristics, medical history, underlying comorbidities, laboratory findings, complications occurring during ICU stay, and mortality were collected and analyzed. Survival and Cox regression analysis were performed to identify risk factors associated with mortality.

Results: Out of 149 patients, 97 (65.1%) were women, and 67 of them were either pregnant or in the early postpartum period. The patients' ages ranged from 16 to 89 years, with a mean (SD) of 44.4 (18.9) years. The need for mechanical ventilation (72.5%) and the development of acute kidney injury (32.9%) were the most frequent complications. Thirty-eight (25.5%) patients died. The subgroup analysis of women showed that being pregnant/postpartum was not associated with a lower frequency of death. However, after adjustment, only increasing age (p<0.001) and a high AST-to-ALT ratio (p<0.001) were independent predictors of death. After adjustment, increasing age (p<0.001) and high AST-to-ALT ratio at admission (p<0.001) were independent predictors of death both in total sample and among women sub-group. High white blood cell count was also associated to death in the total sample analysis.

Conclusion: The most common complications among severe COVID-19 patients in the ICU were the need for mechanical ventilation and acute kidney injury. Increasing age and a high AST-to-ALT ratio at admission were independent predictors of fatality among all patients and even among pregnant/postpartum women.