Clinical features and predictors of severity in COVID-19 patients with critical illness in Singapore

Puah, Ser Hon; Young, Barnaby Edward; Chia, Po Ying; Ho, Vui Kian; Loh, Jiashen; Gokhale, Roshni Sadashiv; Tan, Seow Yen; Sewa, Duu Wen; Kalimuddin, Shirin; Tan, Chee Keat; Pada, Surinder K. M. S.; Cove, Matthew Edward; Chai, Louis Yi Ann; Parthasarathy, Purnima; Ho, Benjamin Choon Heng; Ng, Jensen Jiansheng; Ling, Li Min; Abisheganaden, John A.; Lee, Vernon J. M.; Tan, Cher Heng; Lin, Raymond T. P.; Leo, Yee Sin; Lye, David C.; Yeo, Tsin Wen

We aim to describe a case series of critically and non-critically ill COVID-19 patients in Singapore. This was a multicentered prospective study with clinical and laboratory details. Details for fifty uncomplicated COVID-19 patients and ten who required mechanical ventilation were collected. We compared clinical features between the groups, assessed predictors of intubation, and described ventilatory management in ICU patients. Ventilated patients were significantly older, reported more dyspnea, had elevated C-reactive protein and lactate dehydrogenase. A multivariable logistic regression model identified respiratory rate (aOR 2.83, 95% CI 1.24–6.47) and neutrophil count (aOR 2.39, 95% CI 1.34–4.26) on admission as independent predictors of intubation with area under receiver operating characteristic curve of 0.928 (95% CI 0.828–0.979). Median APACHE II score was 19 (IQR 17–22) and PaO2/FiO2 ratio before intubation was 104 (IQR 89–129). Median peak FiO2 was 0.75 (IQR 0.6–1.0), positive end-expiratory pressure 12 (IQR 10–14) and plateau pressure 22 (IQR 18–26) in the first 24 h of ventilation. Median duration of ventilation was 6.5 days (IQR 5.5–13). There were no fatalities. Most COVID-19 patients in Singapore who required mechanical ventilation because of ARDS were extubated with no mortality.