Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy
Authors: Giacomo Grasselli, Alberto Zangrillo, Alberto Zanella, Massimo Antonelli, Luca Cabrini, Antonio Castelli, Danilo Cereda, Antonio Coluccello, Giuseppe Foti, Roberto Fumagalli, Giorgio Iotti, Nicola Latronico, Luca Lorini, Stefano Merler, Giuseppe Natalini, Alessandra Piatti, Marco Vito Ranieri, Anna Mara Scandroglio, Enrico Storti, Maurizio Cecconi, Antonio Pesenti, Emiliano Agosteo, Valentina Alaimo, Giovanni Albano, Andrea Albertin, Armando Alborghetti, Giorgio Aldegheri, Benvenuto Antonini, Enrico Barbara, Nicolangela Belgiorno, Mirko Belliato, Annalisa Benini, Enrico Beretta, Leonardo Bianciardi, Stefano Bonazzi, Massimo Borelli, Enrico Boselli, Nicola Bronzini, Carlo Capra, Livio Carnevale, Giampaolo Casella, Gianpaolo Castelli, Emanuele Catena, Sergio Cattaneo, Davide Chiumello, Silvia Cirri, Giuseppe Citerio, Sergio Colombo, Davide Coppini, Alberto Corona, Paolo Cortellazzi, Elena Costantini, Remo Daniel Covello, Gianluca De Filippi, Marco Dei Poli, Federica Della Mura, Giulia Evasi, Raquel Fernandez-Olmos, Andrea Forastieri Molinari, Marco Galletti, Giorgio Gallioli, Marco Gemma, Paolo Gnesin, Lorenzo Grazioli, Stefano Greco, Paolo Gritti, Paolo Grosso, Luca Guatteri, Davide Guzzon, Fabiola Harizay, Roberto Keim, Giovanni Landoni, Thomas Langer, Andrea Lombardo, Annalisa Malara, Elena Malpetti, Francesco Marino, Giovanni Marino, Maurizio Giovanni  Mazzoni, Guido Merli, Antonio Micucci, Francesco Mojoli, Stefano Muttini, Adriana Nailescu, Mauro Panigada, Paolo Perazzo, Giovanni Battista Perego, Nicola Petrucci, Angelo Pezzi, Alessandro Protti, Danilo Radrizzani, Maurizio Raimondi, Marco Ranucci, Frank Rasulo, Mario Riccio, Roberto Rona, Claudio Roscitano, Patrizia Ruggeri, Antonello Sala, Giuseppe Sala, Luca Salvi, Pietro Sebastiano, Paolo Severgnini, Ilaria Sforzini, Francesco Donato Sigurtà, Matteo Subert, Paola Tagliabue, Carmine Troiano, Roberto Valsecchi, Uberto Viola, Giovanni Vitale, Massimo Zambon, Elena Zoia
Journal: JAMA (2020)

In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy.Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020.SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs.Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network.Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2O, and Fio2 was greater than 50% in 89% of patients. The median Pao2/Fio2 was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n = 503 aged ≤63 years) and older patients (n = 514 aged ≥64 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2O, respectively; median difference, 0 [95% CI, 0-0]; P = .94). Median Fio2 was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, -10% [95% CI, -14% to 6%]; P = .006), and median Pao2/Fio2 was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, -8 to 22]; P = .02). Patients with hypertension (n = 509) were older than those without hypertension (n = 526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68]; P < .001) and had lower Pao2/Fio2 (median [IQR], 146 [105-214] vs 173 [120-222]; median difference, -27 [95% CI, -42 to -12]; P = .005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n = 786; age ≥64 years) had higher mortality than younger patients (n = 795; age ≤63 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%]; P < .001).In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.