Rapid clinical evolution for COVID-19 translates into early hospital admission and unfavourable outcome: A preliminary report

  • Markus Heim | m.heim@tum.de Department of Anaesthesiology and Intensive Care Medicine, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany, Germany. https://orcid.org/0000-0001-6754-2494
  • Tobias Lahmer Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany. https://orcid.org/0000-0003-1008-5311
  • Sebastian Rasch Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
  • Silja Kriescher Department of Anaesthesiology and Intensive Care Medicine, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
  • Wiebke Berg-Johnson Department of Anaesthesiology and Intensive Care Medicine, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
  • Kristina Fuest Department of Anaesthesiology and Intensive Care Medicine, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany. https://orcid.org/0000-0002-6988-038X
  • Barbara Kapfer Department of Anaesthesiology and Intensive Care Medicine, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
  • Gerhard Schneider Department of Anaesthesiology and Intensive Care Medicine, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
  • Christoph D. Spinner Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany. https://orcid.org/0000-0002-3875-5367
  • Fabian Geisler Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany. https://orcid.org/0000-0003-1545-485X
  • Johannes R. Wießner Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
  • Kathrin Rothe Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Munich, Germany.
  • Susanne Feihl Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Munich, Germany.
  • Andreas Ranft Department of Anaesthesiology and Intensive Care Medicine, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany. https://orcid.org/0000-0002-0530-0796

Abstract

Background: A wide range of mortality rates has been reported in COVID-19 patients on the intensive care unit. We wanted to describe the clinical course and determine the mortality rate in our institution’s intensive care units.
Methods: To this end, we performed a retrospective cohort study of 50 COVID-19 patients admitted to the ICU at a large German tertiary university hospital. Clinical features are reported with a focus on ICU interventions, such as mechanical ventilation, prone positioning and extracorporeal organ support. Outcome is presented using a 7-point ordinal scale on day 28 and 60 following ICU admission.
Results: The median age was 64 years, 78% were male. LDH and D-Dimers were elevated, and patients were low on Vitamin D. ARDS incidence was 75%, and 43/50 patients needed invasive ventilation. 22/50 patients intermittently needed prone positioning, and 7/50 required ECMO. The interval from onset of the first symptoms to admission to the hospital and to the ICU was shorter in non-survivors than in survivors. By day 60 after ICU admission, 52% of the patients had been discharged. 60-day mortality rate was 32%; 37% for ventilated patients, and 42% for those requiring both: ventilation and renal replacement therapy.
Conclusions: Early deterioration might be seen as a warning signal for unfavourable outcome. Lung-protective ventilation including prone positioning remain the mainstay of the treatment.

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Author Biography

Christoph D. Spinner, Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich

German Centre for Infection Research (DZIF), Partner Site Munich, Munich

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Published
2021-04-02
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Conflict of interest statement
Susanne Feihl reports personal fees and non-financial support from Smith and Nephew, personal fees and non-financial support from Curetis, personal fees and non-financial support from Zimmer Biomet, personal fees and non-financial support from Limbach, personal fees and non-financial support from MSD, outside the submitted work; Sebastian Rasch reports travel-grants from Gilead, outside the submitted work. Christoph D. Spinner reports grants from Aperion, grants and personal fees from Gilead Sciences, grants and personal fees from MSD, grants and personal fees from GSK/ViiV Healthcare, grants and personal fees from Janssen-Cilag, personal fees from Molecular Partners, personal fees from Formycon, from null, outside the submitted work; All other authors (Wiebke Berg-Johnson; Kristina Fuest; Fabian Geisler; Markus Heim; Barbara Kapfer; Silja Kriescher; Tobias Lahmer; Kathrin Rothe; Gerhard Schneider; Johannes R. Wießner) have no conflicts of interest to disclose
Keywords:
COVID-19, SARS-CoV-2, critical care, mortality, acute respiratory distress syndrome, prone position, invasive ventilation, retrospective cohort study
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How to Cite
Heim, M., Lahmer, T., Rasch, S., Kriescher, S., Berg-Johnson, W., Fuest, K., Kapfer, B., Schneider, G., Spinner, C., Geisler, F., Wießner, J., Rothe, K., Feihl, S., & Ranft, A. (2021). Rapid clinical evolution for COVID-19 translates into early hospital admission and unfavourable outcome: A preliminary report . Multidisciplinary Respiratory Medicine, 16. https://doi.org/10.4081/mrm.2021.744