Analysis of predictors and outcomes of COVID-19 patients requiring ICU admission from COVID 19
Authors: Kajal Kamal , Singla Karan , Puri Goverdhan Dutt , Bhalla Ashish , Mukherjee Aparna , Kumar Gunjan , Turuk Alka , Premkumar Madhumita , Mahajan Varun , Bingi Thrilok Chander , Bhardwaj Pankaj , John Mary , Menon Geetha R , Sahu Damodar , Panda Samiran , Rao Vishnu Vardhan , Mesipogu Rajarao , Mohiuddin Mohammed Ayaz , Aedula Vinaya Sekhar , Gupta Manoj K , Goel Akhil D , Loomba Vikas , Thomas Maria , Ojha U K , Jha R R , Salgar Veeresh , Algur Santosh , Pathak Ashish , Sharma Ashish , Purohit Manju , Dandu Himanshu , Gupta Amit , Kumar Vivek , Sarangi Lisa , Rath Mahesh , Baruah Tridip Dutta , Kannauje Pankaj Kumar , Kumar Ajit , Joshi Rajnish , Saigal Saurabh , Goel Abhishek , Khambholja Janakkumar R , Patel Amit , Madan Surabhi , Shah Nitesh , Katyal V K , Singh Deepinder , Goyal Sandeep , Shah Arti , Chauhan Amit , Patel Bhavesh , L Kala Yadhav M , P Dayananda V , S Chetana G , Desai Anita , Panchal Manisha , Anderpa Mayank , Tadavi Payal , Bhuniya Sourin , Panigrahi Manoj Kumar , Bal Shakti Kumar , Shivnitwar Sachin K , Lokhande Prajakta , Tripathy Srikanth , Nongpiur Vijay , Pala Star , Jamil Md , Gupta Bal Kishan , Gupta Jigyasa , Upadhyay Rashmi , Srivast Saurabh , Dube Simmi , Dwivedi Preksha , Saxena Rita , Shameem Mohammed , Fatima Nazish , Ahmed Shariq , Shah Nehal M. , Ghosh Soumitra , Ray Yogiraj , Hazra Avijit , Talukdar Arunansu , Dulhani Naveen , Kikon Nyanthung , Mukherjee Subhasis , Mallick Susenjit , Patnaik Lipilekha , Bhandari Sudhir , Agrawal Abhishek , Vohra Rajaat , Sharma Nikita , Bandaru Rajiv Kumar , Mirza Mehdi Ali , Chakravarty Jaya , Kataria Sushila , Choudhury Ratnamala , Chatterji Soumyadip , Kumar M.Pavan 
Published: June 2022

Abstract
BackgroundSevere Corona virus disease (COVID-19) is associated with high mortality. Although single centre intensive care units (ICU) have reported clinical characteristics and outcomes, no large scale multicentric study from India has been published. The present retrospective, multi-centre study was aimed to describe the predictors and outcomes of COVID-19 patients requiring ICU admission from COVID-19 Registry of Indian council of Medical Research (ICMR), India.MethodsProspectively collected data from multiple participating institutions was entered in 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 RT PCR, death within 24 hours of ICU admission, or patients with incomplete data in the registry Their demographic characteristics, laboratory variables, ICU severity indices, treatment strategies and outcomes were analysed.ResultsA total of 5865 patients, with mean age 56±15 years, with 3840/5865 (65.4%) men, were enrolled in the ICMR registry.. Overall mortality was 2535/5865 (43.5%). Non-survivors were older than survivors (58.2±15.4 years vs 53.6 ±14.7 years; P=0.001). Non-survivors had multiple comorbidities (n=1951, 52.9%) with hypertension (47.2%) and diabetes (45.6%) being the most common, higher creatinine (1.6 ± P=0.001, high D-dimer (1.56 vs 1.37, P=0.001), higher CT severity index (16.8±5.2 vs 13.5 ±5.47 ) compared to survivors. Non survivors had longer hospital and ICU stay (P=0.001). On multivariate regression analysis, high NLR (HR 1.017, 95% CI 1.005- 1.029, P=0.001), high CRP (HR 1.008, 95% CI 1.006- 1.010, P=0.001), high D dimer ((HR 1.089, 95% CI 1.065- 1.113, P=0.001) were associated with mechanical ventilation while younger age, (HR 0.974, CI 0.965-0.983, p=0.001), high D dimer (HR-1.014, CI 1.001-1.027, P=0.035) and use of prophylactic LMWH (HR 0.647, CI 0.527-0.794, p=0.001) were independently associated with mortality. ConclusionIn this large retrospective study of 5865 critically ill COVID 19 patients admitted to ICU, overall mortality was 2535/5865 (43.5%). Age, high D dimer, CT Severity score and use of prophylactic LMWH were independently associated with mortality.