Over three quarters of critically ill COVID19 patients required a ventilator, a third required dialysis, finds Lancet study
A large study of adult COVID-19 patients from USA reports that about one in five hospitalised COVID-19 patients develop critical illness and about 80% of these critically ill COVID-19 patients require mechanical ventilation and death rates among such patients are high (39%). Also, more than 80% of these critically ill patients had at least one chronic illness.
A detailed report from 1150 COVID-19 patients admitted to two hospitals in New York City, USA from 2 March to 1 April 2020, and followed for at least 28 days, was published today in The Lancet, offering an overview of how the virus affects adults requiring hospital care.
The study reports a high incidence of critical illness (22%, 257/1150) and a high dependency on mechanical ventilation to support breathing in critically ill patients (79%, 203/257).
People with pre-existing lung or heart conditions had the highest risk of poorer outcomes. High blood pressure was also associated with poorer survival for critically ill patients, consistent with reports from China and Italy
The findings mirror reports from China, Italy and the UK, with older age and pre-existing chronic heart and lung conditions being the strongest risk factors associated with poor outcomes.
The study found 257 out of 1150 patients (22%) were critically ill and required treatment in a high dependency or intensive care unit. The most common symptoms reported were shortness of breath, fever, cough, muscle pain and diarrhoea. As of 28 April 2020, almost 40% of the critically ill patients had died (39%, 101/257) and more than one third remained in hospital (37%, 94/257). Less than one quarter had been discharged alive (23%, 58/257).
More than three quarters of the critically ill patients required mechanical ventilation to help them breathe (79%, 203/257). Patients spent an average of 18 days on a ventilator (range 9-28 days). In addition, almost one third of patients developed severe kidney damage and required therapy to support kidney function, such as dialysis (31%, 79/257).
The majority of critically ill patients were men (67%, 171/257). Critical illness was more common in older patients (median age 62 years) but around one in five patients were aged under 50 (22%, 55/257). More than 80% of critically ill patients had at least one chronic illness, the most common of which were high blood pressure (63%, 162/257) and diabetes (36%, 92/257). Nearly half of the patients were obese (46%, 119/257), consistent with trends seen in the UK. Almost two-thirds of critically ill patients were Hispanic or Latino (62%, 159/257) and around one in five were black or African American (19%, 49/257).
People with pre-existing lung or heart conditions had the highest risk of poorer outcomes. High blood pressure was also associated with poorer survival for critically ill patients, consistent with reports from China and Italy.
5% of critically ill patients were employed as healthcare workers (13/257).
Dr Max O’Donnell, senior author of the study, from Columbia University Irving Medical Centre, USA, said: “Our study provides in-depth understanding of how COVID-19 may be affecting critically ill patients in US hospitals. Of particular interest is the finding that over three quarters of critically ill patients required a ventilator and almost one third required renal dialysis support.”
