Factors Associated with 28-day Critical Illness Development During the First Wave of COVID-19

Uluhan Sili; Pınar Ay; Hüseyin Bilgin; Ahmet Topuzoğlu; Elif Tükenmez-Tigen; Buket Ertürk-Şengel; Dilek Yağçı-Çağlayık; Baran Balcan; Derya Kocakaya; Şehnaz Olgun-Yıldızeli; Fethi Gül; Beliz Bilgili; Rabia Can-Sarınoğlu; Ayşegül Karahasan-Yağcı; Lütfiye Mülazimoğlu-Durmuşoğlu; Emel Eryüksel; Zekaver Odabaşı; Haner Direskeneli; Sait Karakurt; Volkan Korten

doi:10.36519/idcm.2023.206

Factors Associated with 28-day Critical Illness Development During the First Wave of COVID-19

Infect Dis Clin Microbiol. 2023 Jun 23;5(2):94-105. doi: 10.36519/idcm.2023.206. eCollection 2023 Jun.

Authors

Uluhan Sili^{1

2}, Pınar Ay^{3

2}, Hüseyin Bilgin^{1

2}, Ahmet Topuzoğlu^{3

2}, Elif Tükenmez-Tigen¹, Buket Ertürk-Şengel¹, Dilek Yağçı-Çağlayık¹, Baran Balcan⁴, Derya Kocakaya⁴, Şehnaz Olgun-Yıldızeli⁴, Fethi Gül⁵, Beliz Bilgili⁵, Rabia Can-Sarınoğlu⁶, Ayşegül Karahasan-Yağcı⁶, Lütfiye Mülazimoğlu-Durmuşoğlu¹, Emel Eryüksel⁴, Zekaver Odabaşı¹, Haner Direskeneli⁷, Sait Karakurt⁴, Volkan Korten¹

Affiliations

¹ Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, İstanbul, Turkey.
² Equal contribution.
³ Department of Public Health, Marmara University School of Medicine, İstanbul, Turkey.
⁴ Department of Pulmonary Medicine, Marmara University School of Medicine, İstanbul, Turkey.
⁵ Department of Anesthesiology and Intensive Care, Marmara University School of Medicine, İstanbul, Turkey.
⁶ Department of Medical Microbiology, Marmara University School of Medicine, İstanbul, Turkey.
⁷ Department of Internal Medicine, Marmara University School of Medicine, İstanbul, Turkey.

Abstract

Objective: This study aimed to define the predictors of critical illness development within 28 days postadmission during the first wave of the COVID-19 pandemic.

Materials and methods: We conducted a prospective cohort study including 477 PCR-positive COVID-19 patients admitted to a tertiary care hospital in Istanbul from March 12 to May 12, 2020.

Results: The most common presenting symptoms were cough, dyspnea, and fatigue. Critical illness developed in 45 (9.4%; 95% CI=7.0%-12.4%) patients. In the multivariable analysis, age (hazard ratio (HR)=1.05, p<0.001), number of comorbidities (HR=1.33, p=0.02), procalcitonin ≥0.25 µg/L (HR=2.12, p=0.03) and lactate dehydrogenase (LDH) ≥350 U/L (HR=2.04, p=0.03) were independently associated with critical illness development. The World Health Organization (WHO) ordinal scale for clinical improvement on admission was the strongest predictor of critical illness (HR=4.15, p<0.001). The patients hospitalized at the end of the study period had a much better prognosis compared to the patients hospitalized at the beginning (HR=0.14; p=0.02). The C-index of the model was 0.92.

Conclusion: Age, comorbidity number, the WHO scale, LDH, and procalcitonin were independently associated with critical illness development. Mortality from COVID-19 seemed to be decreasing as the first wave of the pandemic advanced.

Graphic abstract: Graphic Abstract.

Keywords: COVID-19; critical illness; prognosis; prospective cohort.