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01-09-2020 | Coronavirus | Original

Increased mortality in patients with severe SARS-CoV-2 infection admitted within seven days of disease onset

Authors: Elie Azoulay, Muriel Fartoukh, Michael Darmon, Guillaume Géri, Guillaume Voiriot, Thibault Dupont, Lara Zafrani, Lola Girodias, Vincent Labbé, Martin Dres, Alexandra Beurton, Antoine Vieillard-Baron, Alexandre Demoule

Published in: Intensive Care Medicine | Issue 9/2020

Abstract

Purpose

Coronavirus disease 2019 (COVID-19) is creating an unprecedented healthcare crisis. Understanding the determinants of mortality is crucial to optimise intensive care unit (ICU) resource use and to identify targets for improving survival.

Methods

In a multicentre retrospective study, we included 379 COVID-19 patients admitted to four ICUs between 20 February and 24 April 2020 and categorised according to time from disease onset to ICU admission. A Cox proportional-hazards model identified factors associated with 28-day mortality.

Results

Median age was 66 years (53–68) and 292 (77%) were men. The main comorbidities included obesity and overweight (67%), hypertension (49.6%) and diabetes (30.1%). Median time from disease onset (i.e., viral symptoms) to ICU admission was 8 (6–11) days (missing for three); 161 (42.5%) patients were admitted within a week of disease onset, 173 (45.6%) between 8 and 14 days, and 42 (11.1%) > 14 days after disease onset; day 28 mortality was 26.4% (22–31) and decreased as time from disease onset to ICU admission increased, from 37 to 21% and 12%, respectively. Patients admitted within the first week had higher SOFA scores, more often had thrombocytopenia or acute kidney injury, had more limited radiographic involvement, and had significantly higher blood IL-6 levels. Age, COPD, immunocompromised status, time from disease onset, troponin concentration, and acute kidney injury were independently associated with mortality.

Conclusion

The excess mortality in patients admitted within a week of disease onset reflected greater non-respiratory severity. Therapeutic interventions against SARS-CoV-2 might impact different clinical endpoints according to time since disease onset.

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Title: Increased mortality in patients with severe SARS-CoV-2 infection admitted within seven days of disease onset
Authors: Elie Azoulay
Muriel Fartoukh
Michael Darmon
Guillaume Géri
Guillaume Voiriot
Thibault Dupont
Lara Zafrani
Lola Girodias
Vincent Labbé
Martin Dres
Alexandra Beurton
Antoine Vieillard-Baron
Alexandre Demoule
Publication date: 01-09-2020
Publisher: Springer Berlin Heidelberg
Keywords: Coronavirus
Acute Kidney Injury
SARS-CoV-2
COVID-19
Acute Kidney Injury
Published in: Intensive Care Medicine / Issue 9/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06202-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Increased mortality in patients with severe SARS-CoV-2 infection admitted within seven days of disease onset

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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