Clinical characteristics and mortality prediction of patients admitted to the Hong Kong East Cluster intensive care units in the COVID‐19 fifth wave
Abstract Introduction COVID‐19 has been threatening global public health since 2019. To address the overwhelming caseload, several tools were developed to predict prognosis and aid triage of critically ill patients for intensive care. Currently, there is a lack of local data on the validity of such...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-02-01
|
| Series: | Hong Kong Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/hkj2.12007 |
| _version_ | 1797289913314443264 |
|---|---|
| author | MY Man SM Lam SYJ Yu JYA Chan MY Lee HP Shum WW Yan |
| author_facet | MY Man SM Lam SYJ Yu JYA Chan MY Lee HP Shum WW Yan |
| author_sort | MY Man |
| collection | DOAJ |
| description | Abstract Introduction COVID‐19 has been threatening global public health since 2019. To address the overwhelming caseload, several tools were developed to predict prognosis and aid triage of critically ill patients for intensive care. Currently, there is a lack of local data on the validity of such tools. Objective The objective of this study is to identify the predictors of intensive care unit (ICU) mortality in COVID‐19 patients in Hong Kong and externally validate the different scoring systems. Methods A retrospective cohort analysis of patients admitted to the HKEC ICUs from 1 January 2022 to 30 April 2022 was performed. We collected data on patient demographics, vaccination status, laboratory parameters, and clinical outcomes including need for organ support and mortality. Clinical severities were estimated by Sequential Organ Failure Score, 4C Mortality Score, COVID‐Gram score, and Acute Physiology and Chronic Health Evaluation (APACHE) IV score based on the original studies. Comparison between individual scoring systems' performance on hospital mortality was conducted and summarized. Results In these four months, 137 patients with COVID‐19 admitted to ICUs of Ruttonjee Hospital and Pamela Youde Nethersole Eastern Hospital were recruited. 64 patients (46.7%) were admitted for COVID‐19 related respiratory failure, among which mortality was 66.7%. The overall hospital and ICU mortality were 21.9% and 13.1%, respectively. Invasive mechanical ventilation (IMV) (OR 3.221, p 0.034), high flow nasal cannula (HFNC) oxygen therapy (OR 3.107, p 0.039), and higher APACHE IV score (OR 1.043, p < 0.001) were independent predictors of hospital mortality using multivariate analysis. The scoring systems had good performance in mortality prediction in our population. The APACHE IV score (AUROC 0.79, 95% CI 0.698–0.894) and 4C Mortality Score (AUROC 0.751, 95% CI 0.657–0.844) outperformed other scoring systems in predicting hospital mortality. Conclusion In patients with COVID‐19, the use of IMV or HFNC and APACHE IV score were independent risk factors for hospital mortality. The APACHE IV and the 4C Mortality Score were most useful in our population for predicting ICU and hospital mortality. |
| first_indexed | 2024-03-07T19:12:53Z |
| format | Article |
| id | doaj.art-0f43d74487984ce9ab277c14a272ddca |
| institution | Directory Open Access Journal |
| issn | 1024-9079 2309-5407 |
| language | English |
| last_indexed | 2024-03-07T19:12:53Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Hong Kong Journal of Emergency Medicine |
| spelling | doaj.art-0f43d74487984ce9ab277c14a272ddca2024-02-29T17:34:04ZengWileyHong Kong Journal of Emergency Medicine1024-90792309-54072024-02-0131131210.1002/hkj2.12007Clinical characteristics and mortality prediction of patients admitted to the Hong Kong East Cluster intensive care units in the COVID‐19 fifth waveMY Man0SM Lam1SYJ Yu2JYA Chan3MY Lee4HP Shum5WW Yan6Department of Intensive Care Pamela Youde Nethersole Eastern Hospital Hong Kong SAR ChinaDepartment of Intensive Care Pamela Youde Nethersole Eastern Hospital Hong Kong SAR ChinaDepartment of Medicine and Geriatrics Ruttonjee & Tang Shiu Kin Hospitals Hong Kong SAR ChinaDepartment of Medicine Pamela Youde Nethersole Eastern Hospital Hong Kong SAR ChinaDepartment of Intensive Care Pamela Youde Nethersole Eastern Hospital Hong Kong SAR ChinaDepartment of Intensive Care Pamela Youde Nethersole Eastern Hospital Hong Kong SAR ChinaDepartment of Intensive Care Pamela Youde Nethersole Eastern Hospital Hong Kong SAR ChinaAbstract Introduction COVID‐19 has been threatening global public health since 2019. To address the overwhelming caseload, several tools were developed to predict prognosis and aid triage of critically ill patients for intensive care. Currently, there is a lack of local data on the validity of such tools. Objective The objective of this study is to identify the predictors of intensive care unit (ICU) mortality in COVID‐19 patients in Hong Kong and externally validate the different scoring systems. Methods A retrospective cohort analysis of patients admitted to the HKEC ICUs from 1 January 2022 to 30 April 2022 was performed. We collected data on patient demographics, vaccination status, laboratory parameters, and clinical outcomes including need for organ support and mortality. Clinical severities were estimated by Sequential Organ Failure Score, 4C Mortality Score, COVID‐Gram score, and Acute Physiology and Chronic Health Evaluation (APACHE) IV score based on the original studies. Comparison between individual scoring systems' performance on hospital mortality was conducted and summarized. Results In these four months, 137 patients with COVID‐19 admitted to ICUs of Ruttonjee Hospital and Pamela Youde Nethersole Eastern Hospital were recruited. 64 patients (46.7%) were admitted for COVID‐19 related respiratory failure, among which mortality was 66.7%. The overall hospital and ICU mortality were 21.9% and 13.1%, respectively. Invasive mechanical ventilation (IMV) (OR 3.221, p 0.034), high flow nasal cannula (HFNC) oxygen therapy (OR 3.107, p 0.039), and higher APACHE IV score (OR 1.043, p < 0.001) were independent predictors of hospital mortality using multivariate analysis. The scoring systems had good performance in mortality prediction in our population. The APACHE IV score (AUROC 0.79, 95% CI 0.698–0.894) and 4C Mortality Score (AUROC 0.751, 95% CI 0.657–0.844) outperformed other scoring systems in predicting hospital mortality. Conclusion In patients with COVID‐19, the use of IMV or HFNC and APACHE IV score were independent risk factors for hospital mortality. The APACHE IV and the 4C Mortality Score were most useful in our population for predicting ICU and hospital mortality.https://doi.org/10.1002/hkj2.12007COVID‐19ICUmortality prediction |
| spellingShingle | MY Man SM Lam SYJ Yu JYA Chan MY Lee HP Shum WW Yan Clinical characteristics and mortality prediction of patients admitted to the Hong Kong East Cluster intensive care units in the COVID‐19 fifth wave Hong Kong Journal of Emergency Medicine COVID‐19 ICU mortality prediction |
| title | Clinical characteristics and mortality prediction of patients admitted to the Hong Kong East Cluster intensive care units in the COVID‐19 fifth wave |
| title_full | Clinical characteristics and mortality prediction of patients admitted to the Hong Kong East Cluster intensive care units in the COVID‐19 fifth wave |
| title_fullStr | Clinical characteristics and mortality prediction of patients admitted to the Hong Kong East Cluster intensive care units in the COVID‐19 fifth wave |
| title_full_unstemmed | Clinical characteristics and mortality prediction of patients admitted to the Hong Kong East Cluster intensive care units in the COVID‐19 fifth wave |
| title_short | Clinical characteristics and mortality prediction of patients admitted to the Hong Kong East Cluster intensive care units in the COVID‐19 fifth wave |
| title_sort | clinical characteristics and mortality prediction of patients admitted to the hong kong east cluster intensive care units in the covid 19 fifth wave |
| topic | COVID‐19 ICU mortality prediction |
| url | https://doi.org/10.1002/hkj2.12007 |
| work_keys_str_mv | AT myman clinicalcharacteristicsandmortalitypredictionofpatientsadmittedtothehongkongeastclusterintensivecareunitsinthecovid19fifthwave AT smlam clinicalcharacteristicsandmortalitypredictionofpatientsadmittedtothehongkongeastclusterintensivecareunitsinthecovid19fifthwave AT syjyu clinicalcharacteristicsandmortalitypredictionofpatientsadmittedtothehongkongeastclusterintensivecareunitsinthecovid19fifthwave AT jyachan clinicalcharacteristicsandmortalitypredictionofpatientsadmittedtothehongkongeastclusterintensivecareunitsinthecovid19fifthwave AT mylee clinicalcharacteristicsandmortalitypredictionofpatientsadmittedtothehongkongeastclusterintensivecareunitsinthecovid19fifthwave AT hpshum clinicalcharacteristicsandmortalitypredictionofpatientsadmittedtothehongkongeastclusterintensivecareunitsinthecovid19fifthwave AT wwyan clinicalcharacteristicsandmortalitypredictionofpatientsadmittedtothehongkongeastclusterintensivecareunitsinthecovid19fifthwave |