Clinical characteristics of patients admitted to an ICU with COVID-19. Predictors of the severe disease

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Abstract

Background. Providing an efficient care to the patients of the most severely affected category — ICU patients — has become one of the serious problems appearing in the COVID-19 pandemics. A typical patient’s clinical portrait in ICUs of COVID centers is very similar in different countries, however, the key to improve the treatment results for critically ill patients has not yet been found. Currently, 160 patients have been treated in the ICU of the FRCC of the FMBA of Russia. To May 16, 2020, the lethality in the ICU was 48.9% by the closed cases, the lethality among the patients on ventilation was 57.9%. The aim of the study is to identify predictors of the severe pneumonia caused by the SARS-CoV-2 virus, and to describe the clinical characteristics of patients admitted to an intensive care unit of the COVID-center of the Federal Research Clinical Center of FMBA of Russia.

Methods. In this report, we describe the clinical, laboratory and instrumental data of 70 patients admitted to the ICU, and discuss the found predictors of the severe COVID-19 pneumonia course.

Results. The following factors have been determined which contribute to the development of the severe course of the disease and to the risk of the unfavorable outcome: male gender, age older than 70.5 years, initial lymphocytopenia of lower than 0.98×109/l, neutrophil to lymphocyte ratio of higher than 7.75, D-dimer level of higher than 0.85 µg/ml, IL-6 of higher than 184.7 pg/ml, procalcitonin of higher than 0.22 ng/ml, hyperglycemia of higher than 9 mmol/l, signs of myocardial damage (high-sensitive troponin Т of higher than 22 pg/ml, echocardiography data), signs of the presence of a secondary bacterial infection and a severe vitamin D deficiency (lower than 9.9 ng/ml). The pathophysiological basics for the contribution of each factor to the severe course of the disease are provided.

Conclusions. Clinical features of the patients change in course of pandemia. These influenced by changes in treatment approaches and new discoveries in disease pathophysiology. Above mentioned predictors of severe course of disease is partly modifiable and we are able to influence them and perhaps achieve better results in treatment of severe patients with COVID-19

About the authors

Tatiana V. Klypa

Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia

Email: tvklypa@gmail.com
ORCID iD: 0000-0002-2732-967X

MD, PhD

Russian Federation, 28, Orekhoviy blvd, Moscow, 115682

Mikhail V. Bychinin

Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia

Email: drbychinin@gmail.com
ORCID iD: 0000-0001-8461-4867

MD, PhD

Russian Federation, 28, Orekhoviy blvd, Moscow, 115682

Irina A. Mandel

Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia; Sechenov First Moscow State Medical Univesity

Author for correspondence.
Email: irina.a.mandel@gmail.com
ORCID iD: 0000-0001-9437-6591

MD, PhD

Russian Federation, 28, Orekhoviy blvd, Moscow, 115682; 8-2, Trubetskaya street, Moscow, 119992

Sergey A. Andreichenko

Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia

Email: sergandletter@gmail.com
ORCID iD: 0000-0002-3180-3805

врач анестезиолог-реаниматолог 

Russian Federation, 28, Orekhoviy blvd, Moscow, 115682

Andrey I. Minets

Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia

Email: minets.andrei@mail.ru
ORCID iD: 0000-0003-0382-4104

MD, PhD

Russian Federation, 28, Orekhoviy blvd, Moscow, 115682

Nadezhda A. Kolyshkina

Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia

Email: baklab_83@mail.ru
ORCID iD: 0000-0003-4486-5412
Russian Federation, 28, Orekhoviy blvd, Moscow, 115682

Aleksandr V. Troitsky

Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia

Email: dr.troitskiy@gmail.com
ORCID iD: 0000-0003-2411-6043

MD, PhD, Professor

Russian Federation, 28, Orekhoviy blvd, Moscow, 115682

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Supplementary files

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2. Fig. 1. Distribution of patients in the intensive care and intensive care units of the Federal State Budgetary Institution FNKTs FMBA of Russia by age

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3. Fig. 2. The prognostic value of age, troponin T level, neutrophil-leukocyte ratio, D-dimer, procalcitone, interleukin 6, lymphocytopenia in determining the risk of developing an unfavorable outcome of the disease

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Copyright (c) 2020 Klypa T.V., Bychinin M.V., Mandel I.A., Andreichenko S.A., Minets A.I., Kolyshkina N.A., Troitsky A.V.

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