Introduction

Patients with severe COVID-19 can develop ventilator-dependent acute hypoxic respiratory failure (VDAHRF), which is associated with a higher mortality rate. We evaluated the clinical course of hospitalized COVID-19 patients and compared them with the patients who received invasive mechanical ventilation. Characteristics of intubated patients who were successfully weaned from the ventilator were compared with the patients who failed to be extubated or died in the hospital.

Objective

To investigate the clinical course of hospitalized COVID-19 patients, and assess the possible predictors of the disease severity leading to VDAHRF.

Methods

This is a single-center, retrospective study. The first 129 patients (18 years or older) with COVID-19 admitted to Monmouth Medical Center from March 1st to April 25th, 2020 were included.

Results

Out of 129 patients, 23.25% (n = 30) required invasive mechanical ventilation, and of those, six patients were successfully weaned from the ventilator. Multivariable logistic regression analysis showed increased odds of intubation associated with hypoxemia (odds ratio 17.23, 95% CI 5.206–57.088; p < 0.0001), elevated d-dimer by one unit mg/L of FEU (odds ratio 1.515, 95% CI 5.206–57.088; p = 0.0430) and elevated ferritin by one unit ng/ml (odds ratio 1.001, 95% CI 1.000–1.001, p = 0.0051) on admission, adjusted for other covariates.

Conclusions

Patients who required invasive mechanical ventilation were more likely to have older age, male gender, coronary artery disease, diabetes, and obesity. The patients who were successfully weaned from the ventilator were more likely to be younger in age, and none of them had heart failure or CAD.

中文翻译：

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美国三级医院的 COVID-19 患者：临床过程评估和疾病严重程度的预测因素。

介绍

患有严重 COVID-19 的患者可能会出现呼吸机依赖型急性缺氧性呼吸衰竭 (VDAHRF)，这与较高的死亡率相关。我们评估了住院 COVID-19 患者的临床过程，并将其与接受有创机械通气的患者进行了比较。将成功脱离呼吸机的插管患者的特征与拔管失败或在医院死亡的患者进行了比较。

客观的

调查住院 COVID-19 患者的临床过程，并评估导致 VDAHRF 的疾病严重程度的可能预测因素。

方法

这是一项单中心的回顾性研究。包括 2020 年 3 月 1 日至 4 月 25 日在蒙茅斯医疗中心收治的首批 129 名 COVID-19 患者（18 岁或以上）。

结果

在 129 名患者中，23.25% (n = 30) 需要有创机械通气，其中 6 名患者成功脱离呼吸机。多变量逻辑回归分析显示，与低氧血症相关的插管几率增加（优势比 17.23，95% CI 5.206-57.088；p < 0.0001），d-二聚体升高 1 mg/L FEU（优势比 1.515，95% CI 5.206 –57.088；p = 0.0430），入院时铁蛋白升高 1 个单位 ng/ml（优势比 1.001，95% CI 1.000–1.001，p = 0.0051），并针对其他协变量进行了调整。

结论

需要有创机械通气的患者更有可能患有高龄、男性、冠状动脉疾病、糖尿病和肥胖症。成功脱离呼吸机的患者年龄更小，且均未出现心力衰竭或 CAD。