Risk Factors for COVID-19 Adverse Outcomes in ICU Settings of Various Types Repurposed Hospitals

Objective: to study the risk factors for COVID-19 adverse outcomes in repurposed hospitals of various types.
Material and methods. A retrospective study was conducted in the ICUs of three repurposed hospitals: a municipal hospital, a federal center and a private clinic. Data of 369 patients were analyzed for the period from April to December 2020. Gender, age, BMI, NEWS score, severity of lung damage based on CT quantification, blood gases and pH, patterns of antibiotic administration during hospital stay (all classes and number of antimicrobials, regardless the sequence of administration), patterns of main drugs administration (glucocorticosteroids, lopinavir/ritonavir, tocilizumab/ solilumab, hydroxychloroquine) were evaluated as risk factors. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated by logistic regression.
Results. Patients from repurposed hospitals of various types were distinguishable in terms of distribution by sex, severity of lung damage, administered therapy, blood gases, and the number of antimicrobials used. Mortality rates were 21.8% in the federal center, 41.4% in the private clinic, and 77.2% in the municipal hospital. The most significant risk factors were: the severity of lung damage based on CT quantification (OR=3.694, 95% CI: 1.014–13.455, P=0.048) — in the federal center, patient’s age (OR=1.385, 95% CI: 1.034–1.854, P=0.029) and arterial oxygen tension (OR=0.806, 95% CI: 0.652–0.996) — in the municipal hospital, and patients’ age (OR=2.158, 95% CI: 1.616–2.880, P0.0001), number of antibiotics (OR=1.79, 95% CI: 1.332–2.406, P=0.0001), and blood pH (OR=0.381, 95% CI: 0.261–0.555, P0.0001) — in the private clinic.
Conclusion. Patient’s profiles in municipal, federal, and private ICU settings varied significantly in the first wave of the COVID-19 pandemic. Gender distribution and severity of the diseases were found as the most significant differences among them. Clinical outcomes were also different, with the lowest mortality rate in the federal center and the highest in the municipal hospital. Arterial pO_₂, blood pH, and the number of antimicrobials used in the course of treatment were the significant risk factors of fatal outcome (in some hospitals).

1. Li Y., Ashcroft T., Chung A., Dighero I., Dozier M., Horne M., McSwiggan E. et al. Risk factors for poor outcomes in hospitalized COVID-19 patients: a systematic review and meta-analysis. J Glob Health. 2021; 11: 10001. DOI: 10.7189/jogh.11.10001. PMID: 33767855

2. Telle K.E., Grøsland M., Helgeland J., Håberg S.E. Factors associated with hospitalization, invasive mechanical ventilation treatment and death among all confirmed COVID-19 cases in Norway: prospective cohort study. Scand J Public Health. 2021; 49 (1): 41–47. DOI: 10.1177/1403494820985172. PMID: 33461404

3. Macedo M.C.F., Pinheiro I.M., Carvalho C.J.L., Fraga H.C.J.R., Araujo I.P.C., Montes S.S., Araujo O.A.C. et al. Correlation between hospitalized patients’ demographics, symptoms, comorbidities, and COVID-19 pandemic in Bahia, Brazil. PLoS One. 2020; 15 (12): e0243966. DOI: 10.1371/journal.pone.0243966. PMID: 33318711

4. Allameh S.F., Nemati S., Ghalehtaki R., Mohammadnejad E., Aghili S.M., Khajavirad N., Beigmohammadi M-T. et al. Clinical characteristics and outcomes of 905 COVID-19 patients admitted to Imam Khomeini hospital complex in the capital city of Tehran, Iran. Arch Iran Med. 2020; 23 (11): 766–775. DOI: 10.34172/AIM.2020.102. PMID: 33220695

5. Jiménez E., Fontán-Vela M., Valencia J., Fernandez-Jimenez I., Álvaro-Alonso E.A., Izquierdo-García E., Cebas A.L. et al. Characteristics, complications and outcomes among 1549 patients hospitalized with COVID-19 in a secondary hospital in Madrid, Spain: a retrospective case series study. BMJ Open. 2020; 10 (11): e042398. DOI: 10.1136/bmjopen-2020-042398. PMID: 33172949

6. Mironov P.I., Lutfarakhmanov I.I., Syrchin E.Yu., Dombrovskaya A.A., Pushkarev V.A., Shiryaev A.P. Predictors of death in patients with COVID-19 on artificial lung ventilation. Bashkortostan Medical Journal/ Meditsinskiy Vestnik Bashkortostana. 2020; 15 (6): 86–92 (In Russ.).

7. Glybochko P., Fomin V., Avdeev S.,Moiseev S.,Yavorovskiy A., Brovko M. et al. Clinical Characteristics of 1007 Intensive Care Unit Patients with Sars-Cov-2 Pneumonia. Clinical Pharmacology and Therapy/ Clinical Pharmacology and Therapy/Klinicheskaya Farmakologiya i Terapiya. 2020; 29: 21–29 (In Russ.). DOI: 10.32756/0869-5490-2020-2-21-29

8. Klypa T.V., Bychinin M.V., Mandel I.A., Andreichenko S.A., Minets A.I., Kolyshkina N.A., Troitsky A.V. Clinical characteristics of patients admitted to an ICU with COVID-19. Predictors of the severe disease. Clinical practice/Klinicheskaya Praktika. 2020; 11 (2): 6–20. (In Russ.). DOI: 10.17816/clinpract34182

9. Elamari S., Motaib I., Zbiri S., Elaidaoui K., Chadli A., Elkettani C. Characteristics and outcomes of diabetic patients infected by the SARS-CoV-2. Pan Afr Med J. 2020; 37: 32. DOI: 10.11604/pamj.2020.37.32.25192. PMID: 33209159

10. Payán-Pernía S., Pérez L.G., Remacha Sevilla Á.F., Gil J.S., Canales S.N. Absolute lymphocytes, ferritin, C-reactive protein, and lactate dehydrogenase predict early invasive ventilation in patients with COVID-19. Lab Med. 2021; 52 (2): 141–145. DOI: 10.1093/labmed/lmaa105. PMID: 33336243

11. Gupta B., Jain G., Chandrakar S., Gupta N., Agarwal A. Arterial blood gas as a predictor of mortality in COVID pneumonia patients initiated on noninvasive mechanical ventilation: a retrospective analysis. Indian J Crit Care Med. 2021; 25 (8): 866–871. DOI: 10.5005/jp-journals-10071-23917. PMID: 34733025

12. Tian W., Jiang W., Yao J., Nicholson C.J., Li R.H., Sigurslid H.H., Wooster L. et al. Predictors of mortality in hospitalized COVID-19 patients: a systematic review and meta-analysis. J Med Virol. 2020; 92 (10): 1875–1883. DOI: 10.1002/jmv.26050. PMID: 32441789

13. Shi C., Wang L., Ye J., Gu Z., Wang S., Xia J., Xia Y., Li Q. et al. Predictors of mortality in patients with coronavirus disease 2019: a systematic review and meta-analysis. BMC Infect Dis. 2021; 21 (1): 663. DOI: 10.1186/s12879-021-06369-0. PMID: 34238232

14. Bendala Estrada A.D., Parra J.C., Carracedo E.F., Míguez A.M., Martínez A.R., Rubio E.M., Rubio-Rivas M., Inadequate use of antibiotics in the COVID-19 era: effectiveness of antibiotic therapy. BMC Infect Dis. 2021; 21 (1): 1144. DOI: 10.1186/s12879-021-06821-1. PMID: 34749645

15. Moiseev S.V., Avdeev S.N., Tao E.A., Brovko M.Yu., Yavorovsky A.G., Umbetova K.T. Efficacy of tocilizumab in the intensive care unit patients with COVID-19: a retrospective cohort study. Clinical Pharmacology and Therapy/ Klinicheskaya Farmakologiya i Terapiya. 2020; 29 (4): 17–25. (In Russ.). DOI: 10.32756/ 0869-5490-2020-4-17-25

16. Amani B., Khanijahani A., Amani B., Hashemi P. Lopinavir/ritonavir for COVID-19: a systematic review and meta-analysis. Pharm Sci. 2021; 24: 246–257. DOI: 10.18433/jpps31668. PMID: 34048671

17. Axfors C., Schmitt A.M., Janiaud P, van’t Hooft J., Abd-Elsalam S., Abdo E.F., Abella B.S. et al. Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. Nat Commun. 2021; 12 (1): 2349. DOI: 10.1038/s41467-021-22446-z. PMID: 33859192

18. Yu G.Q., Jiang Z-.H., Yang Z.-B., Jiang S.-Q., Quan X.-Q. The effect of glucocorticoids on mortality in severe COVID-19 patients: evidence from 13 studies involving 6612 cases. Medicine (Baltimore). 2021; 100 (40): e27373. DOI: 10.1097/MD.0000000000027373. PMID: 34622840

19. Sterne J.A.C., Murthy S., Diaz J. V., Slutsky A.S., Villar J., Angus D.C., Annane D. et al. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis. JAMA. 2020; 324 (13): 1330–1341. DOI: 10.1001/jama.2020.17023. PMID: 32876694

20. Ermokhina L.V., Mityashov A.S., Perekhodov S.N., Chaus N.I., Karpun N.A., Baeva A.A., Yadgarov M.Ya. et al. What treatment really make sense for critically ill patients with COVID-19: single-center retrospective cohort study. Ann Crit Care/ Vestnik Intensivnoy Terapii im AI Saltanova. 2021; (3): 69–79. (In Russ.). DOI: 10.21320/1818-474X-2021-3-69-79

21. Bychinin M.V., Klypa T.V., Mandel I.A., Korshunov D.I., Kolyshkina N.A., Dzheliev R.A. Clinical and laboratory characteristics of intensive care patients of the first and second waves of the COVID-19 pandemic. Russian Journal of Anaesthesiology and Reanimatology/Anesteziologiya i Reanimatologiya. 2022; (4): 57–65. (In Russ.). DOI: 10.17116/anaesthesiology202204157