Acute Crit Care.  2020 Nov;35(4):242-248. 10.4266/acc.2020.00619.

Clinical characteristics and outcomes of critically Ill patients with COVID-19 in Northeast Ohio: low mortality and length of stay

• Fadel FA
• Al-Jaghbeer M
• Kumar S
• Griffiths L
• Wang X
• Han X
• Burton R

• KMID: 2510542
• DOI: http://doi.org/10.4266/acc.2020.00619

Abstract

Background
Published coronavirus disease 2019 (COVID-19) reports suggest higher mortality with increasing age and comorbidities. Our study describes the clinical characteristics and outcomes for all intensive care unit (ICU) patients admitted across the Cleveland Clinic enterprise, a 10-hospital health care system in Northeast Ohio, serving more than 2.7 million people.
Methods
We analyzed the quality data registry for clinical characteristics and outcomes of all COVID-19-confirmed ICU admissions. Differences in outcomes from other health care systems and published cohorts from other parts of the world were delineated.
Results
Across our health care system, 495 COVID-19 patients were admitted from March 15 to June 1, 2020. Mean patient age was 67.3 years, 206 (41.6%) were females, and 289 (58.4%) were males. Mean Acute Physiology Score was 45.3, and mean Acute Physiology and Chronic Health Evaluation III score was 60.5. In total, 215 patients (43.3%) were intubated for a mean duration of 9.2 days. Mean ICU and hospital length of stay were 7.4 and 13.9 days, respectively, while mean ICU and hospital mortality rates were 18.4% and 23.8%.
Conclusions
Our health care system cohort is the fourth largest to be reported. Lower ICU and hospital mortality and length of stay were seen compared to most other published reports. Better preparedness and state-level control of the surge in COVID-19 infections are likely the reasons for these better outcomes. Future research is needed to further delineate differences in mortality and length of stay across health care systems and over time.

Keyword

cohort; COVID 19; critical illness; hospital mortality; intensive care unit; mechanical ventilation; pandemic

Reference

1. World Health Organization. WHO coronavirus disease (COVID-19) dashboard [Internet]. Geneva: World Health Organization;2020. [cited 2020 Jul 31]. Available from: https://covid19.who.int.

2. Ohio Department of Health COVID-19 Dashboard [Internet]. 2020. [cited 2020 Jul 31]. Available from: https://coronavirus.ohio.gov/wps/portal/gov/covid-19/dashboards/overview.

3. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area. JAMA. 2020; 323:2052–9.

4. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395:1054–62.

5. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA. 2020; 323:1574–81.

6. Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in critically ill patients in the Seattle region: case series. N Engl J Med. 2020; 382:2012–22.

7. Gupta S, Hayek SS, Wang W, Chan L, Mathews KS, Melamed ML, et al. Factors associated with death in critically ill patients With coronavirus disease 2019 in the US. JAMA Intern Med. 2020; Jul. 15. [Epub]. https://doi.org/10.1001/jamainternmed.2020.3596.

8. Mitra AR, Fergusson NA, Lloyd-Smith E, Wormsbecker A, Foster D, Karpov A, et al. Baseline characteristics and outcomes of patients with COVID-19 admitted to intensive care units in Vancouver, Canada: a case series. CMAJ. 2020; 192:E694–701.

9. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020; 8:475–81.

10. Wang Y, Lu X, Li Y, Chen H, Chen T, Su N, et al. Clinical course and outcomes of 344 intensive care patients with COVID-19. Am J Respir Crit Care Med. 2020; 201:1430–4.

11. Armstrong RA, Kane AD, Cook TM. Outcomes from intensive care in patients with COVID-19: a systematic review and metaanalysis of observational studies. Anaesthesia. 2020; 75:1340–9.

12. Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington state. JAMA. 2020; 323:1612–4.

13. Intensive Care National Audit and Research Centre. ICNARC report on COVID-19 in critical care [Internet]. London: Intensive Care National Audit and Research Centre;2020. [cited 2020 Jul 31]. Available from: https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports.

14. Centers for Disease Control and Prevention. Diabetes surveillance system [Internet]. Atlanta (GA): Centers for Disease Control and Prevention;[cited 2020 Jul 31]. Available from: https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html.

15. von Baum H, Schweiger B, Welte T, Marre R, Suttorp N, Pletz MW, et al. How deadly is seasonal influenza-associated pneumonia? The German Competence Network for Community-Acquired Pneumonia. Eur Respir J. 2011; 37:1151–7.