J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 13, Number 3, March 2021, pages 184-190

Declining Intensive Care Unit Mortality of COVID-19: A Multi-Center Study

**Table 1.** Demographic Information, Baseline Comorbidities and Admission Laboratory Values
Parameters	All (n)	Alive n (%)	Dead n (%)	P value
BMI: body mass index; HTN: hypertension; COPD: chronic obstructive pulmonary disease; CKD: chronic kidney disease; CHF: congestive heart failure; N: number; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; LDH: lactate dehydrogenase.
N	1,204	734 (61)	470 (39)	< 0.05
Age (mean)	66	62	70	< 0.05
Sex
Male	715	433 (59)	282 (60)	0.73
Female	489	301 (41)	188 (40)
Race
White	622	380 (52)	242 (52)	0.45
African American	418	248 (34)	170 (36)
Hispanic	32	24 (3)	8 (2)
Asian	99	63 (9)	36 (8)
Unknown	32	18 (3)	14 (3)
BMI (mean)	32	32	32	0.87
HTN	725	434 (59)	291 (62)	0.34
Dyslipidemia	381	235 (32)	146 (31)	0.73
Diabetes	539	320 (44)	219 (47)	0.31
COPD	26	13 (2)	13 (3)	0.25
CKD	129	72 (10)	57 (12)	0.21
CHF	177	117 (16)	60 (13)	0.13
Smoking	192	126 (17)	66 (14)	0.15
Asthma	122	83 (11)	39 (8)	0.09
Atrial fibrillation	128	79 (11)	49 (10)	0.85
Admission mortality risk score
Minor	3	3 (0.4)	0 (0)	< 0.05
Moderate	30	30 (4)	0 (0)
Major	169	154 (21)	15 (3)
Extreme	964	515 (70)	449 (95)
Not available	38	32 (4)	6 (1)
Mean labs value on day 1
CRP, mg/L	13.2	12.7	13.8	0.36
D-dimer, ng/mL	2,101	1,902	2,296	0.40
ESR, mm/h	5912	4483	7342	< 0.05
Ferritin, mg/L	1,472	1,323	1,620	0.29
Fibrinogen, mg/dL	623	632	614	0.41
LDH, U/L	482	545	420	0.09

Table 1. Demographic Information, Baseline Comorbidities and Admission Laboratory Values

Parameters

All (n)

Alive n (%)

Dead n (%)

P value

BMI: body mass index; HTN: hypertension; COPD: chronic obstructive pulmonary disease; CKD: chronic kidney disease; CHF: congestive heart failure; N: number; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; LDH: lactate dehydrogenase.

1,204

734 (61)

470 (39)

< 0.05

Age (mean)

< 0.05

Sex

Male

715

433 (59)

282 (60)

0.73

Female

489

301 (41)

188 (40)

Race

White

622

380 (52)

242 (52)

0.45

African American

418

248 (34)

170 (36)

Hispanic

24 (3)

8 (2)

Asian

63 (9)

36 (8)

Unknown

18 (3)

14 (3)

BMI (mean)

0.87

HTN

725

434 (59)

291 (62)

0.34

Dyslipidemia

381

235 (32)

146 (31)

0.73

Diabetes

539

320 (44)

219 (47)

0.31

COPD

13 (2)

13 (3)

0.25

CKD

129

72 (10)

57 (12)

0.21

CHF

177

117 (16)

60 (13)

0.13

Smoking

192

126 (17)

66 (14)

0.15

Asthma

122

83 (11)

39 (8)

0.09

Atrial fibrillation

128

79 (11)

49 (10)

0.85

Admission mortality risk score

Minor

3 (0.4)

0 (0)

< 0.05

Moderate

30 (4)

0 (0)

Major

169

154 (21)

15 (3)

Extreme

964

515 (70)

449 (95)

Not available

32 (4)

6 (1)

Mean labs value on day 1

CRP, mg/L

13.2

12.7

13.8

0.36

D-dimer, ng/mL

2,101

1,902

2,296

0.40

ESR, mm/h

5912

4483

7342

< 0.05

Ferritin, mg/L

1,472

1,323

1,620

0.29

Fibrinogen, mg/dL

623

632

614

0.41

LDH, U/L

482

545

420

0.09

**Table 2.** Crude and Adjusted Mortality Trend by Month
Month	Admissions (n)	Mortality (%)	P value	AOR (95% CI)	P value
Factors that were adjusted for mortality trend by month included patients’ age, gender, ethnicity, comorbidities (diabetes mellitus, hypertension, dyslipidemia, heart failure, smoking, chronic obstructive pulmonary disease, asthma, atrial fibrillation, chronic kidney disease, and stroke), medications (hydroxychloroquine, tocilizumab, remdesivir, steroids), admission laboratory values (CRP, ESR, D-dimer, ferritin, fibrinogen, lactate dehydrogenase) and admission risk of mortality score. AOR: adjusted odds ratio; CI: confidence interval; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate.
March	142	46	< 0.05	16.81 (3.59 - 78.78)	< 0.05
April	530	46		10.25 (2.58 - 40.79)	< 0.05
May	290	38		5.59 (1.48 - 21.14)	< 0.05
June	105	25		3.46 (.793 - 15.13)	0.09
July	88	23		2.73 (0.64 - 11.58)	0.18
August	49	14		Reference group
Total	1,204	39	< 0.05

Table 2. Crude and Adjusted Mortality Trend by Month

Month

Admissions (n)

Mortality (%)

P value

AOR (95% CI)

P value

Factors that were adjusted for mortality trend by month included patients’ age, gender, ethnicity, comorbidities (diabetes mellitus, hypertension, dyslipidemia, heart failure, smoking, chronic obstructive pulmonary disease, asthma, atrial fibrillation, chronic kidney disease, and stroke), medications (hydroxychloroquine, tocilizumab, remdesivir, steroids), admission laboratory values (CRP, ESR, D-dimer, ferritin, fibrinogen, lactate dehydrogenase) and admission risk of mortality score. AOR: adjusted odds ratio; CI: confidence interval; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate.

March

142

< 0.05

16.81 (3.59 - 78.78)

< 0.05

April

530

10.25 (2.58 - 40.79)

< 0.05

May

290

5.59 (1.48 - 21.14)

< 0.05

June

105

3.46 (.793 - 15.13)

0.09

July

2.73 (0.64 - 11.58)

0.18

August

Reference group

Total

1,204

< 0.05

**Table 3.** ICU Interventions, Peak Laboratory Values and Outcomes in COVID-19 Patients
Interventions	All (n)	Alive n (%)	Died n (%)	P value	Odds ratio
ICU: intensive care unit; BiPAP: bilevel positive airway pressure; ECMO: extracorporeal membrane oxygenation; HFNC: high-flow nasal cannula; HCQ: hydroxychloroquine; TCZ: tocilizumab; LOS: length of stay; LDH: lactate dehydrogenase; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; SNF: skilled nursing facility; NH: nursing home; AMA: against medical advice.
N	1,204	734 (61)	470 (39)	< 0.05
Mechanical ventilation	713	340 (46)	373 (79)	< 0.05	0.22 (0.12 - 0.29)
Duration		7 ± 13	7 ± 9	0.44
BiPAP	399	212 (29)	187 (40)	< 0.05	0.62 (0.48 - 0.79)
Duration		1 ± 3	1 ± 3	0.12
ECMO	27	16 (2%)	11 (2)	0.85	0.93 (0.43 - 2.01)
Duration		1 ± 0.1	1 ± 0.15	0.85
Nitric oxide	2	1 (0.1)	1 (0.2)	0.75	0.64 (0.40 - 10.25)
HFNC	573	370 (50)	203 (43)	< 0.05	1.33 (1.05 - 1.68)
Flolan	97	26 (3.5)	71 (15)	< 0.05	0.20 (0.13 - 0.32)
Medications
HCQ	476	265 (56)	211 (44)	< 0.05	1.44 (1.13 - 1.82)
Duration		2 ± 3	2 ± 3	0.17
TCZ	272	162 (60)	110 (40)	0.64	0.93 (0.70 - 1.22)
Duration		0.3 ± 0.6	0.3 ± 0.6	0.29
Remdesivir	162	105 (65)	57 (35)	0.32	1.21 (0.86 - 1.71)
Duration		1 ± 2	1 ± 2	0.29
Steroids	602	357 (59)	245 (41)	0.26	0.87 (0.69 - 1.09)
Duration		4 ± 6	4 ± 6	0.84
Laboratory values
D-dimer peak	5,912	4,483	7,342	< 0.05
Ferritin peak	3,942	1,953	5,931	< 0.05
LDH peak	782	567	998	< 0.05
CRP peak	22	20	24	< 0.05
ESR peak	65	68	62	0.46
Outcomes
Comfort care	136	11 (2)	125 (26)	< 0.05	0.04 (0.02 - 0.07)
Hospital LOS		18 ± 16	12 ± 10	< 0.05
ICU LOS		9 ± 12	8 ± 9	0.08
Discharge location	716
Inpatient rehabilitation		295 (42)
SNF		212 (30)
Home/NH		137 (19)
Hospice		56 (8)
AMA		8 (1)

Table 3. ICU Interventions, Peak Laboratory Values and Outcomes in COVID-19 Patients

Interventions

All (n)

Alive n (%)

Died n (%)

P value

Odds ratio

ICU: intensive care unit; BiPAP: bilevel positive airway pressure; ECMO: extracorporeal membrane oxygenation; HFNC: high-flow nasal cannula; HCQ: hydroxychloroquine; TCZ: tocilizumab; LOS: length of stay; LDH: lactate dehydrogenase; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; SNF: skilled nursing facility; NH: nursing home; AMA: against medical advice.

1,204

734 (61)

470 (39)

< 0.05

Mechanical ventilation

713

340 (46)

373 (79)

< 0.05

0.22 (0.12 - 0.29)

Duration

7 ± 13

7 ± 9

0.44

BiPAP

399

212 (29)

187 (40)

< 0.05

0.62 (0.48 - 0.79)

Duration

1 ± 3

0.12

ECMO

16 (2%)

11 (2)

0.85

0.93 (0.43 - 2.01)

Duration

1 ± 0.1

1 ± 0.15

0.85

Nitric oxide

1 (0.1)

1 (0.2)

0.75

0.64 (0.40 - 10.25)

HFNC

573

370 (50)

203 (43)

< 0.05

1.33 (1.05 - 1.68)

Flolan

26 (3.5)

71 (15)

< 0.05

0.20 (0.13 - 0.32)

Medications

HCQ

476

265 (56)

211 (44)

< 0.05

1.44 (1.13 - 1.82)

Duration

2 ± 3

0.17

TCZ

272

162 (60)

110 (40)

0.64

0.93 (0.70 - 1.22)

Duration

0.3 ± 0.6

0.29

Remdesivir

162

105 (65)

57 (35)

0.32

1.21 (0.86 - 1.71)

Duration

1 ± 2

0.29

Steroids

602

357 (59)

245 (41)

0.26

0.87 (0.69 - 1.09)

Duration

4 ± 6

0.84

Laboratory values

D-dimer peak

5,912

4,483

7,342

< 0.05

Ferritin peak

3,942

1,953

5,931

< 0.05

LDH peak

782

567

998

< 0.05

CRP peak

< 0.05

ESR peak

0.46

Outcomes

Comfort care

136

11 (2)

125 (26)

< 0.05

0.04 (0.02 - 0.07)

Hospital LOS

18 ± 16

12 ± 10

< 0.05

ICU LOS

9 ± 12

8 ± 9

0.08

Discharge location

716

Inpatient rehabilitation

295 (42)

SNF

212 (30)

Home/NH

137 (19)

Hospice

56 (8)

AMA

8 (1)