Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State - JAM

19-03-2020

Aim
Letter, description of clinical presentation, characteristics and outcomes of CIVID-19.

Key findings

• Poor short-term outcomes among patients requiring mechanical ventilation.

Summary

• 21 cases included, mean age 70, 52% male, 86% comorbidities (most common: chronic kidney disease (47.6%) and congestive heart failure (42.9%)).
• Main initial symptoms: shortness of breath (76%), fever (52%), and cough (48%). 
  • Mean onset of symptoms prior to hospital presentation: 3.5 days. 
  • 17/21 (81%) admitted to the ICU <24 hours after hospital admission.
• Abnormal chest X-ray in 20 patients (95%) at admission. Most common findings: bilateral reticular nodular opacities (11 [52%]) and ground-glass opacities (10 [48%]).
  • By 72h hours, 86% had bilateral reticular nodular opacities and 67% had evidence of ground-glass opacities. 
• The mean white blood cell count was 9365 μL at admission, 14/21 (67%) had a normal white blood cell count. 14/21 (67%) had an absolute lymphocyte count of <1000 cells/μL. Liver function tests were abnormal in 8/21 (38%) at admission.
• Mechanical ventilation was initiated in 15/21 (71%), ARDS observed in 15/15 and 8 of 15 (53%) developed severe ARDS by <72 hours.
• Cardiomyopathy developed in 7 patients (33%). 
• Mortality was 67% and 24% of patients have remained critically ill and 9.5% have been discharged from the ICU.