Analysis of Predictors and Outcomes of COVID-19 Patients Requiring ICU Admission from COVID-19 Registry, India

Kamal Kajal; Karan Singla; Goverdhan Dutt Puri; Ashish Bhalla; Aparna Mukherjee; Gunjan Kumar; Alka Turuk; Madhumita Premkumar; Varun Mahajan; Naveen B Naik; Thrilok Chander Bingi; Pankaj Bhardwaj; Mary John; Geetha R Menon; Damodar Sahu; Samiran Panda; Vishnu Vardhan Rao; COVID-National Clinical Registry for COVID-19 Team

doi:10.5005/jp-journals-10071-24496

Analysis of Predictors and Outcomes of COVID-19 Patients Requiring ICU Admission from COVID-19 Registry, India

Indian J Crit Care Med. 2023 Aug;27(8):552-562. doi: 10.5005/jp-journals-10071-24496.

Authors

Kamal Kajal¹, Karan Singla¹, Goverdhan Dutt Puri¹, Ashish Bhalla², Aparna Mukherjee³, Gunjan Kumar³, Alka Turuk⁴, Madhumita Premkumar⁵, Varun Mahajan¹, Naveen B Naik¹, Thrilok Chander Bingi⁶, Pankaj Bhardwaj⁷, Mary John⁸, Geetha R Menon⁹, Damodar Sahu⁹, Samiran Panda¹⁰, Vishnu Vardhan Rao⁹; COVID-National Clinical Registry for COVID-19 Team

Affiliations

¹ Department of Anaesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
² Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
³ Department of Clinical Studies, Trials and Projection Unit, Indian Council of Medical Research, Delhi, India.
⁴ National Clinical Registry for COVID-19, Indian Council of Medical Research, Delhi, India.
⁵ Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
⁶ Department of Medicine, Gandhi Medical College, Secunderabad, Telangana, India.
⁷ Community Medicine and Family Medicine, All Indian Institute of Medical Sciences, Jodhpur, Rajasthan, India.
⁸ Department of Medicine, Christian Medical College & Hospital, Ludhiana, Punjab, India.
⁹ National Institute of Medical Statistics, Indian Council of Medical Research, Delhi, India.
¹⁰ Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India.

Abstract

Background: Patients admitted to intensive care units (ICUs) with severe coronavirus disease (COVID-19) are associated with high mortality. The present retrospective, multicenter study describes the predictors and outcomes of COVID-19 patients requiring ICU admission from COVID-19 Registry of Indian Council of Medical Research (ICMR), India.

Materials and methods: Prospectively collected data from participating institutions were entered into the electronic National Clinical Registry of COVID-19. We enrolled patients aged >18 years with COVID-19 pneumonia requiring ICU admission between March 2020 and August 2021. Exclusion criteria were negative in RT-PCR report, death within 24 hours of ICU admission, or incomplete data. Their demographic and laboratory variables, ICU severity indices, treatment strategies, and outcomes were analyzed.

Results: A total of 5,865 patients were enrolled. Overall mortality was 43.2%. Non-survivors were older (58.2 ± 15.4 vs 53.6 ± 14.7 years; p = 0.001), had multiple comorbidities (33.2% vs 29.5%, p = 0.001), had higher median D-dimer (1.56 vs 1.37, p = 0.015), higher CT severity index (16.8 ± 5.2 vs 13.5 ± 5.47, p = 0.001) and longer median hospital stay (10 vs 8 days, p = 0.001) and ICU stay (5 vs 4 days, p = 0.001), compared with survivors.On multivariate analysis, high CRP (HR 1.008, 95% CI: 1.006-1.010, p = 0.001) and high D-dimer (HR 1.089, 95% CI: 1.065-1.113, p < 0.001) were associated with invasive mechanical ventilation while older age (HR 1.19, CI: 1.001-1.038, p = 0.039) and high D-dimer (HR-1.121, CI: 1.072-1.172, p = 0.001) were independently associated with mortality and while the use of prophylactic low molecular weight heparin (LMWH) (HR 0.647, CI: 0.527-0.794, p = 0.001) lowered mortality.

Conclusion: Among 5,865 COVID-19 patients admitted to ICU, mortality was 43.5%. High CRP and D-dimers were independently associated with the need for invasive mechanical ventilation while older age and high D-dimer were associated with higher mortality. The use of prophylactic LMWH independently reduced mortality.

How to cite this article: Kajal K, Singla K, Puri GD, Bhalla A, Mukherjee A, Kumar G, et al. Analysis of Predictors and Outcomes of COVID-19 Patients Requiring ICU Admission from COVID-19 Registry, India. Indian J Crit Care Med 2023;27(8):552-562.

Keywords: COVID-19; COVID-19 registry; ICU patients; Outcome.