COVID-19 and intensive care medicine

Clinical characteristics and factors associated with ICU mortality during the first year of the SARS-Cov-2 pandemic in Romania

A prospective, cohort, multicentre study of 9000 patients

Bubenek-Turconi, Şerban-Ion; Andrei, Stefan; Văleanu, Liana; Ştefan, Mihai-Gabriel; Grigoraş, Ioana; Copotoiu, Sanda; Bodolea, Constantin; Tomescu, Dana; Popescu, Mihai; Filipescu, Daniela; Moldovan, Horatiu; Rogobete, Alexandru-Florin; Bălan, Cosmin; Moroşanu, Bianca; Săndesc, Dorel; Arafat, Raed

Author Information

From the Anesthesiology and Intensive Care Department, Carol Davila University of Medicine and Pharmacy (Ş-IB-T, SA, DT, MP, DF, BM), Cardiac Anesthesiology and Intensive Care Department I, Emergency Institute for Cardiovascular Diseases Prof. Dr C. C. Iliescu, Bucharest, Romania (Ş-IB-T, LV, CB, BM), Anaesthesiology and Critical Care Department, Dijon Bourgogne University Hospital, Dijon, France (SA), Cardiac Anesthesiology and Intensive Care Department II, Emergency Institute for Cardiovascular Diseases Prof. Dr C. C. Iliescu, Bucharest, Romania (M-GŞ, DF), Anaesthesiology and Intensive Care Department, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania (IG), Anaesthesiology and Intensive Care Department, Regional Institute of Oncology, Iaşi, Romania (IG), Anaesthesiology and Intensive Care Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (SC), Anaesthesiology and Intensive Care Department II, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca (CB), Anaesthesiology and Intensive Care Department III, Fundeni Clinical Institute (DT, MP), Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461, Bucharest, Romania; Department of Cardiovascular Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania (HM), Anaesthesiology and Intensive Care Department, Emergency County Hospital Pius Brinzeu (FR, DS), Anaesthesiology and Intensive Care Department, Victor Babeş University of Medicine and Pharmacy, Timişoara (FR, DS) and Department for Emergency Situations, Ministry of Internal Affairs, Bucharest, Romania (RA)

Correspondence to Stefan Andrei, Anesthesiology and Intensive Care Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania. E-mail: [email protected]

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European Journal of Anaesthesiology 40(1):p 4-12, January 2023. | DOI: 10.1097/EJA.0000000000001776

Abstract

BACKGROUND

The epidemiology of critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be different worldwide. Despite similarities in medicine quality and formation, there are also significant differences concerning healthcare and ICU organisation, staffing, financial resources and population compliance and adherence. Large cohort data of critically ill patients from Central and Eastern Europe are also lacking.

OBJECTIVES

The study objectives were to describe the clinical characteristics of patients admitted to Romanian ICUs with SARS-CoV-2 infection and to identify the factors associated with ICU mortality.

DESIGN

Prospective, cohort, observational study.

SETTING

National recruitment, multicentre study, between March 2020 to March 2021.

PATIENTS

All patients with SARS-CoV-2 infection admitted to Romanian ICUs were eligible. There were no exclusion criteria.

INTERVENTION

None.

MAIN OUTCOME MEASURE

ICU mortality.

RESULTS

The statistical analysis included 9058 patients with definitive ICU outcome. The multivariable mixed effects logistic regression model found that age [odds ratio (OR) 1.27; 95% confidence interval (CI), 1.23 to 1.31], male gender (OR 1.21; 95% CI 1.05 to 1.4), medical history of neoplasia (OR 1.74; 95% CI, 1.36 to 2.22), chronic kidney disease (OR 1.54; 95% CI, 1.27 to 1.88), type II diabetes (OR 1.23; 95% CI, 1.06 to 1.43), chronic heart failure (OR 1.24; 95% CI, 1.03 to 1.49), dyspnoea (OR 1.3; 95% CI, 1.1 to 1.5), SpO2 less than 90% (OR 3; 95% CI, 2.5 to 3.5), admission SOFA score (OR 1.07; 95% CI, 1.05 to 1.09), acute respiratory distress syndrome (ARDS) on ICU admission (OR 1.35; 95% CI, 1.1 to 1.63) and the need for noninvasive (OR 1.8, 95% CI, 1.5 to 1.22) or invasive ventilation (OR 28; 95% CI, 22 to 35) and neuromuscular blockade (OR 3.5; 95% CI, 2.6 to 4.8), were associated with larger ICU mortality.

Higher GCS on admission (OR 0.81; 95% CI, 0.79 to 0.83), treatment with hydroxychloroquine (OR 0.78; 95% CI, 0.64 to 0.95) and tocilizumab (OR 0.58; 95% CI, 0.48 to 0.71) were inversely associated with ICU mortality.

CONCLUSION

The SARS-CoV-2 critically ill Romanian patients share common personal and clinical characteristics with published European cohorts. Public health measures and vaccination campaign should focus on patients at risk.

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Clinical characteristics and factors associated with ICU mortality during the first year of the SARS-Cov-2 pandemic in Romania

A prospective, cohort, multicentre study of 9000 patients