Clinical characteristics and outcomes of critically ill patients with COVID-19 admitted to an intensive care unit in London: A prospective observational cohort study.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

COVID-19/*epidemiology ; Critical Illness/*epidemiology ; Multiple Organ Failure/*epidemiology ; Obesity/*epidemiology; Adult ; Aged ; COVID-19/complications ; COVID-19/therapy ; COVID-19/virology ; Cohort Studies ; Female ; Hospital Mortality ; Humans ; Intensive Care Units ; London/epidemiology ; Male ; Middle Aged ; Multiple Organ Failure/complications ; Multiple Organ Failure/virology ; Obesity/complications ; Obesity/therapy ; Obesity/virology ; Patient Discharge ; Prospective Studies ; Respiration, Artificial ; SARS-CoV-2/pathogenicity ; Severity of Illness Index ; Treatment Outcome ; United Kingdom/epidemiology

Background: Cohorts of severely ill patients with COVID-19 have been described in several countries around the globe, but to date there have been few published reports from the United Kingdom (UK). Understanding the characteristics of the affected population admitted to intensive care units (ICUs) in the UK is crucial to inform clinical decision making, research and planning for future waves of infection.
Methods: We conducted a prospective observational cohort study of all patients with COVID-19 admitted to a large UK ICU from March to May 2020 with follow-up to June 2020. Data were collected from health records using a standardised template. We used multivariable logistic regression to analyse the factors associated with ICU survival.
Results: Of the 156 patients included, 112 (72%) were male, 89 (57%) were overweight or obese, 68 (44%) were from ethnic minorities, and 89 (57%) were aged over 60 years of age. 136 (87%) received mechanical ventilation, 77 (57% of those intubated) were placed in the prone position and 95 (70% of those intubated) received neuromuscular blockade. 154 (99%) patients required cardiovascular support and 44 (28%) required renal replacement therapy. Of the 130 patients with completed ICU episodes, 38 (29%) died and 92 (71%) were discharged alive from ICU. In multivariable models, age (OR 1.13 [95% CI 1.07-1.21]), obesity (OR 3.06 [95% CI 1.16-8.74]), lowest P/F ratio on the first day of admission (OR 0.82 [95% CI 0.67-0.98]) and PaCO2 (OR 1.52 [95% CI 1.01-2.39]) were independently associated with ICU death.
Conclusions: Age, obesity and severity of respiratory failure were key determinants of survival in this cohort. Multiorgan failure was prevalent. These findings are important for guiding future research and should be taken into consideration during future healthcare planning in the UK.
Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: DM has received consultancy and lecture fees from Edwards Lifesciences and Siemens Healthineers; none of the other authors have any conflicts of interest to report. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Crit Care Med. 2021 Jan 1;49(1):e105-e107. (PMID: 32991357)
J Zhejiang Univ Sci B. 2020 May;21(5):378-387. (PMID: 32425003)
JAMA. 2020 Apr 28;323(16):1574-1581. (PMID: 32250385)
Crit Care. 2020 Jul 6;24(1):394. (PMID: 32631393)
Lancet Respir Med. 2020 Jul;8(7):738-742. (PMID: 32416769)
Intensive Care Med. 2020 Nov;46(11):2035-2047. (PMID: 33034689)
Intensive Care Med. 2020 Jul;46(7):1303-1325. (PMID: 32514598)
Lancet Haematol. 2020 Jun;7(6):e438-e440. (PMID: 32407672)
Lancet Respir Med. 2020 May;8(5):475-481. (PMID: 32105632)
Am J Respir Crit Care Med. 2020 Jun 1;201(11):1430-1434. (PMID: 32267160)
N Engl J Med. 2013 Jun 6;368(23):2159-68. (PMID: 23688302)
J Intensive Care Soc. 2020 May;21(2):99-101. (PMID: 32489403)
J Infect. 2020 Aug;81(2):e82-e84. (PMID: 32405109)
Crit Care. 2020 Jun 4;24(1):285. (PMID: 32498689)
Acta Anaesthesiol Scand. 2021 Jan;65(1):76-81. (PMID: 32892337)
Med Intensiva (Engl Ed). 2020 Dec;44(9):589-590. (PMID: 32425288)
Front Med (Lausanne). 2020 Oct 07;7:569714. (PMID: 33117831)
Acta Anaesthesiol Scand. 2021 Mar;65(3):351-359. (PMID: 33128800)
Lancet Infect Dis. 2020 Sep;20(9):1034-1042. (PMID: 32422204)
Anaesthesia. 2020 Oct;75(10):1340-1349. (PMID: 32602561)
Thromb Res. 2020 Jul;191:145-147. (PMID: 32291094)
Crit Care Med. 2020 Sep;48(9):e799-e804. (PMID: 32452888)
Lancet. 2020 Jun 6;395(10239):1763-1770. (PMID: 32442528)
Z Gesundh Wiss. 2022;30(2):361-364. (PMID: 32318325)
Br J Haematol. 2020 Aug;190(3):e134-e137. (PMID: 32484907)
Intensive Care Med. 2020 Sep;46(9):1779-1780. (PMID: 32572526)
Bull Math Biol. 2020 Apr 8;82(4):52. (PMID: 32270376)
N Engl J Med. 2020 May 21;382(21):2012-2022. (PMID: 32227758)

Date Created: 20201215 Date Completed: 20201222 Latest Revision: 20231104

20240104

PMC7737956

10.1371/journal.pone.0243710

33320904