Clinical characteristics and outcomes of critically ill coronavirus disease 2019 patients in Malaysia during the first wave: A multi-center observational study (COVIDICU-MY)
BackgroundCoronavirus disease 2019 (COVID-19) emerged with a wide range of clinical presentations; Malaysia was not spared from its impact. This study describes the clinical characteristics of COVID-19 patients admitted to intensive care unit, their clinical course, management, and hospital outcomes...
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Frontiers Media S.A.
2023-01-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.1086288/full |
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| author | Noor Iftitah Ab Rahman Nor’azim Mohd Yunos Rafidah Atan Jeevitha Mariapun Mohd Ali‘Imran Ab Rahman Abdul Jabbar Ismail Shanti Rudra Deva |
| author_facet | Noor Iftitah Ab Rahman Nor’azim Mohd Yunos Rafidah Atan Jeevitha Mariapun Mohd Ali‘Imran Ab Rahman Abdul Jabbar Ismail Shanti Rudra Deva |
| author_sort | Noor Iftitah Ab Rahman |
| collection | DOAJ |
| description | BackgroundCoronavirus disease 2019 (COVID-19) emerged with a wide range of clinical presentations; Malaysia was not spared from its impact. This study describes the clinical characteristics of COVID-19 patients admitted to intensive care unit, their clinical course, management, and hospital outcomes.MethodsCOVIDICU-MY is a retrospective analysis of COVID-19 patients from 19 intensive care units (ICU) across Malaysia from 1 March 2020 to 31 May 2020. We collected epidemiological history, demographics, clinical comorbidities, laboratory investigations, respiratory and hemodynamic values, management, length of stay and survival status. We compared these variables between survival and non-survival groups.ResultsA total of 170 critically ill patients were included, with 77% above 50 years of age [median age 60, IQR (51–66)] and 75.3% male. Hypertension, diabetes mellitus, hyperlipidemia, chronic cardiac disease, and chronic kidney disease were most common among patients. A high Simplified Acute Physiology Score (SAPS) II score [median 45, IQR (34–49)] and Sequential Organ Failure Assessment (SOFA) score [median 8, IQR (6–11)] were associated with mortality. Patients were profoundly hypoxic with a median lowest PaO2/FiO2 ratio of 150 (IQR 99–220) at admission. 91 patients (53.5%) required intubation on their first day of admission, out of which 38 died (73.1% of the hospital non-survivors). Our sample had more patients with moderate Acute Respiratory Distress Syndrome (ARDS), 58 patients (43.9%), compared to severe ARDS, 33 patients (25%); with both ARDS classification groups contributing to 25 patients (54.4%) and 11 patients (23.9%) of the non-survival group, respectively. Cumulative fluid balance over 24 h was higher in the non-survival group with significant differences on Day 3 (1,953 vs. 622 ml, p < 0.05) and Day 7 of ICU (3,485 vs. 830 ml, p < 0.05). Patients with high serum creatinine, urea, lactate dehydrogenase, aspartate aminotransferase and d-dimer, and low lymphocyte count throughout the stay also had a higher risk of mortality. The hospital mortality rate was 30.6% in our sample.ConclusionWe report high mortality amongst critically ill patients in intensive care units in Malaysia, at 30.6%, during the March to May 2020 period. High admission SAPS II and SOFA, and severe hypoxemia and high cumulative fluid balance were associated with mortality. Higher creatinine, urea, lactate dehydrogenase, aspartate aminotransferase and d-dimer, and lymphopenia were observed in the non-survival group. |
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| issn | 2296-858X |
| language | English |
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| spelling | doaj.art-0ea6c791d4bc4f8c89743a6d5f9d4e2a2023-01-09T09:25:36ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-01-01910.3389/fmed.2022.10862881086288Clinical characteristics and outcomes of critically ill coronavirus disease 2019 patients in Malaysia during the first wave: A multi-center observational study (COVIDICU-MY)Noor Iftitah Ab Rahman0Nor’azim Mohd Yunos1Rafidah Atan2Jeevitha Mariapun3Mohd Ali‘Imran Ab Rahman4Abdul Jabbar Ismail5Shanti Rudra Deva6Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya Medical Centre, Universiti Malaya, Kuala Lumpur, MalaysiaDepartment of Anaesthesiology, Faculty of Medicine, Universiti Malaya Medical Centre, Universiti Malaya, Kuala Lumpur, MalaysiaDepartment of Anaesthesiology, Faculty of Medicine, Universiti Malaya Medical Centre, Universiti Malaya, Kuala Lumpur, MalaysiaClinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, MalaysiaDepartment of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MalaysiaFaculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, MalaysiaDepartment of Anaesthesiology and Intensive Care, Hospital Kuala Lumpur, Kuala Lumpur, MalaysiaBackgroundCoronavirus disease 2019 (COVID-19) emerged with a wide range of clinical presentations; Malaysia was not spared from its impact. This study describes the clinical characteristics of COVID-19 patients admitted to intensive care unit, their clinical course, management, and hospital outcomes.MethodsCOVIDICU-MY is a retrospective analysis of COVID-19 patients from 19 intensive care units (ICU) across Malaysia from 1 March 2020 to 31 May 2020. We collected epidemiological history, demographics, clinical comorbidities, laboratory investigations, respiratory and hemodynamic values, management, length of stay and survival status. We compared these variables between survival and non-survival groups.ResultsA total of 170 critically ill patients were included, with 77% above 50 years of age [median age 60, IQR (51–66)] and 75.3% male. Hypertension, diabetes mellitus, hyperlipidemia, chronic cardiac disease, and chronic kidney disease were most common among patients. A high Simplified Acute Physiology Score (SAPS) II score [median 45, IQR (34–49)] and Sequential Organ Failure Assessment (SOFA) score [median 8, IQR (6–11)] were associated with mortality. Patients were profoundly hypoxic with a median lowest PaO2/FiO2 ratio of 150 (IQR 99–220) at admission. 91 patients (53.5%) required intubation on their first day of admission, out of which 38 died (73.1% of the hospital non-survivors). Our sample had more patients with moderate Acute Respiratory Distress Syndrome (ARDS), 58 patients (43.9%), compared to severe ARDS, 33 patients (25%); with both ARDS classification groups contributing to 25 patients (54.4%) and 11 patients (23.9%) of the non-survival group, respectively. Cumulative fluid balance over 24 h was higher in the non-survival group with significant differences on Day 3 (1,953 vs. 622 ml, p < 0.05) and Day 7 of ICU (3,485 vs. 830 ml, p < 0.05). Patients with high serum creatinine, urea, lactate dehydrogenase, aspartate aminotransferase and d-dimer, and low lymphocyte count throughout the stay also had a higher risk of mortality. The hospital mortality rate was 30.6% in our sample.ConclusionWe report high mortality amongst critically ill patients in intensive care units in Malaysia, at 30.6%, during the March to May 2020 period. High admission SAPS II and SOFA, and severe hypoxemia and high cumulative fluid balance were associated with mortality. Higher creatinine, urea, lactate dehydrogenase, aspartate aminotransferase and d-dimer, and lymphopenia were observed in the non-survival group.https://www.frontiersin.org/articles/10.3389/fmed.2022.1086288/fullCOVID-19critically illintubationacute respiratory distress syndromemortalityprone |
| spellingShingle | Noor Iftitah Ab Rahman Nor’azim Mohd Yunos Rafidah Atan Jeevitha Mariapun Mohd Ali‘Imran Ab Rahman Abdul Jabbar Ismail Shanti Rudra Deva Clinical characteristics and outcomes of critically ill coronavirus disease 2019 patients in Malaysia during the first wave: A multi-center observational study (COVIDICU-MY) Frontiers in Medicine COVID-19 critically ill intubation acute respiratory distress syndrome mortality prone |
| title | Clinical characteristics and outcomes of critically ill coronavirus disease 2019 patients in Malaysia during the first wave: A multi-center observational study (COVIDICU-MY) |
| title_full | Clinical characteristics and outcomes of critically ill coronavirus disease 2019 patients in Malaysia during the first wave: A multi-center observational study (COVIDICU-MY) |
| title_fullStr | Clinical characteristics and outcomes of critically ill coronavirus disease 2019 patients in Malaysia during the first wave: A multi-center observational study (COVIDICU-MY) |
| title_full_unstemmed | Clinical characteristics and outcomes of critically ill coronavirus disease 2019 patients in Malaysia during the first wave: A multi-center observational study (COVIDICU-MY) |
| title_short | Clinical characteristics and outcomes of critically ill coronavirus disease 2019 patients in Malaysia during the first wave: A multi-center observational study (COVIDICU-MY) |
| title_sort | clinical characteristics and outcomes of critically ill coronavirus disease 2019 patients in malaysia during the first wave a multi center observational study covidicu my |
| topic | COVID-19 critically ill intubation acute respiratory distress syndrome mortality prone |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.1086288/full |
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