Poor prognosis of patients with severe COVID-19 admitted to an infectious disease intensive care unit during the pandemic caused by the Delta variant in Japan

Keigo Sekihara; Takatoshi Shibasaki; Tatsuya Okamoto; Chihiro Matsumoto; Kuniaki Ito; Kana Fujimoto; Fumito Kato; Wataru Matsuda; Kentaro Kobayashi; Ryo Sasaki; Tatsuki Uemura; Akio Kimura; Haruhito Sugiyama; Norihiro Kokudo

doi:10.35772/ghm.2021.01121

Poor prognosis of patients with severe COVID-19 admitted to an infectious disease intensive care unit during the pandemic caused by the Delta variant in Japan

Glob Health Med. 2022 Apr 30;4(2):122-128. doi: 10.35772/ghm.2021.01121.

Authors

Keigo Sekihara¹, Takatoshi Shibasaki^{1

2}, Tatsuya Okamoto¹, Chihiro Matsumoto¹, Kuniaki Ito¹, Kana Fujimoto¹, Fumito Kato^{1

2}, Wataru Matsuda², Kentaro Kobayashi², Ryo Sasaki², Tatsuki Uemura^{1

2}, Akio Kimura^{1

2}, Haruhito Sugiyama³, Norihiro Kokudo⁴

Affiliations

¹ Department of Intensive Care Medicine, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan.
² Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan.
³ Department of Respiratory Medicine, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan.
⁴ Department of Surgery, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan.

Abstract

During the surge of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) delta variant, our institution operated an intensive care unit (ICU) for patients with severe COVID-19. The study aim was to determine the survival rate and treatment outcomes of patients with severe COVID-19 treated in the ICU during the surge. A total of 23 consecutive patients with severe COVID-19 were admitted to the ICU between August 5 and October 6, 2021. Patients received multidrug therapy consisting of remdesivir, tocilizumab, heparin, and methylprednisolone. The patients were divided into two groups based on the ordinal scale (OS): a non-invasive oxygen therapy (OS-6) group, and an invasive oxygen therapy (OS-7) group. There were 13 (57%) and 10 (43%) patients in the OS-7 and OS-6 groups, respectively. All patients were unvaccinated. Sixteen patients (70%) were male. The median age was 53 years; the median body mass index (BMI) was 30.3 kg/m2; and the median P/F ratio on admission was 96. The 30-day survival rate was 69% and was significantly poorer in the OS-7 group (54%) than in the OS-6 group (89%; p = 0.05). The prevalence of obesity (p = 0.05) and the Sequential Organ Failure Assessment (SOFA) score on admission (p < 0.01) were significantly higher in the OS-7 group. Seven patients in the OS-7 group (54%) developed bacteremia. A low P/F ratio on admission was a significant unfavorable prognostic factor (hazard ratio: 10.9; p = 0.03). The survival rate was poor, especially in patients requiring invasive oxygen therapy. More measures are needed to improve the treatment outcomes of patients with severe COVID 19.

Keywords: SARS-CoV-2 infection; mechanical ventilation; mortality; secondary hospital-acquired infection.

2022, National Center for Global Health and Medicine.