Risk factors associated with intensive care unit (ICU) admission and in-hospital death among adults hospitalized with COVID-19: a two-center retrospective observational study in tertiary care hospitals

Shayganfar, Azin; Sami, Ramin; Sadeghi, Somayeh; Dehghan, Mehrnegar; Khademi, Nilufar; Rikhtegaran, Reyhaneh; Basiratnia, Reza; Ferdosi, Felora; Hajiahmadi, Somayeh

BACKGROUND: The COVID-19 pandemic is straining the health care systems worldwide. Therefore, health systems should make strategic shifts to ensure that limited resources provide the highest benefit for COVID-19 patients. OBJECTIVE: This study aimed to describe the risk factors associated with poor in-hospital outcomes to help clinicians make better patient care decisions. MATERIAL AND METHODS: This retrospective observational study enrolled 176 laboratory-confirmed COVID-19 patients. Demographic characteristics, clinical data, lymphocyte count, CT imaging findings on admission, and clinical outcomes were collected and compared. Two radiologists evaluated the distribution and CT features of the lesions and also scored the extent of lung involvement. The receiver operating characteristic (ROC) curve was used to determine the optimum cutoff point for possible effective variables on patients’ outcomes. Multivariable logistic regression models were used to determine the risk factors associated with ICU admission and in-hospital death. RESULT: Thirty-eight (21.5%) patients were either died or admitted to ICU from a total of 176 enrolled ones. The mean age of the patients was 57.5 ± 16.1 years (males: 61%). The best cutoff point for predicting poor outcomes based on age, CT score, and O(2) saturation was 60 years (sensitivity: 71%, specificity: 62%), 10.5 (sensitivity: 73%, specificity: 58%), and 90.5% (sensitivity: 73%, specificity: 59%), respectively. CT score cutoff point was rounded to 11 since this score contains only integer numbers. Multivariable-adjusted regression models revealed that ages of ≥ 60 years, CT score of ≥ 11, and O(2) saturation of ≤ 90.5% were associated with higher worse outcomes among study population (odds ratio (OR): 3.62, 95%CI: 1.35–9.67, P = 0.019; OR: 4.38, 95%CI: 1.69–11.35, P = 0.002; and OR: 2.78, 95%CI: 1.03–7.47, P = 0.042, respectively). CONCLUSION: The findings indicate that older age, higher CT score, and lower O(2) saturation could be categorized as predictors of poor outcome among COVID-19-infected patients. Other studies are required to prove these associations.