What are the survival rates of intubated patients, by age and by comorbidity

Posted on June 7, 2020 by Rakesh Dewan

Summary

Older age and one or more chronic medical illness (namely cardiovascular disease, pulmonary disease and diabetes) was associated with a greater risk of development of ARDS, invasive mechanical ventilation and death (1,2,3).

I.   BRIEF LITERATURE SCAN OF CURRENT EVIDENCE

    • In a single-center retrospective observational study, 52 critically ill adult Chinese patients with COVID-19 were admitted to ICU (1). There were 20 survivors and 32 non-survivors (1).
      • Demographics and baseline characteristics of patients with severe SARS-CoV-2-pneumonia are seen in Table 1.     
        • Survivors (n=20): 15% received invasive ventilation and 45% developed ARDS
        • Non-Survivors (n=32): 59% received invasive ventilation and 81% developed ARDS 
      • Age: mean age of survivors was 51.9 and non-survivors was 64.6
        • The majority of non-survivors were aged 60-69 (34%) followed by 50-59 (28%) and then followed by 70-79 (22%). Only 6% were greater than or equal to 80 years of age.
      • Sex: 34% of non-survivors were female while 66% were male
      • Medical Conditions: 50% of non-survivors had a chronic medical condition while only 25% of survivors had a chronic medical condition
        • Chronic cardiac disease (9%), chronic pulmonary disease (6%), cerebrovascular disease (22%), diabetes (22%), malignancy (3%), dementia (3%), malnutrition (3%) and smoking (0%) were seen in non-survivors

     

    • In a retrospective, multicenter cohort study of a 191 adults aged 18 years or older with COVID-19, 54 patient died in hospital (2). The study found increasing odds of in-hospital death associated with older age and higher SOFA scores (2).
      • Demographics and clinical characteristics seen in Table 1 (2). 
        • 32 patients required invasive mechanical ventilation of whom 31 (97%) died (2).
        • ARDS was present in 98% of non-survivors vs. 54% of survivors (2).
        • Sepsis was present in 100% of non-survivors vs. 59% of survivors (2).
      • Age: mean age of survivors was 52 and non-survivors was 69
      • Sex: 30% of non-survivors were female while 70% were male
      • Medical Conditions: 67% of non-survivors had a chronic medical condition while only 40% of survivors had a chronic medical condition
        • Hypertension (48%), diabetes (31%), coronary heart disease (24%), chronic obstructive lung disease (7%), carcinoma (0%), chronic kidney disease (4%), and other (20%) were seen in non-survivors

     

    • Another retrospective cohort study of 201 patients with confirmed COVID-19 pneumonia found that 41.8% of patients developed ARDS, 33.3% received mechanical ventilation and of those 52.4% died (3). 
      • Among the patients that developed ARDS, 27.4% had hypertension vs only 13.7% had hypertension in those patients that did not develop ARDS (3). Among the patients that had developed ARDS, 19% had diabetes vs. only 5.1% had diabetes in those patients that did not develop ARDS (3).
      • Patients with ARDS were older (difference, 12.0 years; 95% CI, 8.0-16.0 years; P < .001) (3). Compared with patients without ARDS, patients with ARDS had a higher proportion of comorbidities, including hypertension (difference, 13.7%; 95% CI, 1.3%-26.1%; P = .02) and diabetes (difference, 13.9%; 95% CI, 3.6%-24.2%; P = .002) (3).
      • Older age (≥65 years old), high fever (≥39 °C), comorbidities (e.g. hypertension, diabetes), neutrophilia, lymphocytopenia (as well as lower CD3 and CD4 Tc ell counts), elevated end-organ related indices (e.g. AST, urea, LDH), elevated inflammation-related indices (high sensitivity C-reactive protein and serum ferritin), and elevated coagulation function–related indicators (PT and D dimer) were significantly associated with higher risks of the development of ARDS (3).
      • Clinical characteristics among patients with and without ARDS seen in Table 3 (3).

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References

  1. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine [Internet]. 2020 Feb 24;0(0). Available from: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30079-5/fulltext
  2. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet [Internet]. 2020 Mar; Available from: https://www.thelancet.com/pb-assets/Lancet/pdfs/S014067362305663.pdf
  3. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Internal Medicine. 2020 Mar 13

Disclaimer

The above is intended to serve as a rapidly-created, accessible source of information curated by medical students and healthcare professionals. It is for educational purposes only and is not a complete reference resource. It is not professional medical advice, and is not a substitute for the discretion, judgment, and duties of healthcare professionals. You are solely responsible for evaluating the information above.