Older Age, Need for Ventilators Among Similar Traits of Italians with COVID-19

A majority of patients in the Lombardy region of Italy with confirmed COVID-19 infection required mechanical ventilation, according to a paper published in JAMA.

Investigators from Italy retrospectively examined 1591 critically ill patients admitted to the hospital between Feb. 20 and March 18, 2020 in order to determine what were the baseline characteristics and outcomes of patients infected by the novel coronavirus and admitted to the intensive care unit (ICU). The first patient in Italy was diagnosed on Feb. 20 and brought to an ICU in Lombardy. A total of 17,713 people tested positive for COVID-19 through March 18 and of those, 9%, or 1591 patients, were admitted to the ICU. That was the group the study authors examined in their analysis. Most of the patients in the analysis were admitted to the ICU because of acute hypoxemic respiratory failure that required respiratory support, the study authors wrote.

For comparison, in China, the origin of the global outbreak, the percentage of patients with COVD-19 who required ICU care ranged from 5% to 32%, the investigators said.

A majority of the patients were male (82%), the study authors reported. The median age among patients was 63 years. The investigators classified patients as “younger” if they were 63 years old or less, and “older” if they were aged 64 or older.

Two-thirds of the patients had at least 1 comorbidity, most commonly hypertension (49% of patients with a comorbidity), the study authors found. Other comorbidities, such as cardiovascular disease and hypercholesterolemia were noted. A small group had a history of COPD. All of the patients aged 80 years or older had at least 1 comorbidity.

Almost all of the patients who had respiratory support data available and were admitted to the ICU needed invasive or noninvasive respiratory support: 1287 of 1300 patients, the study authors determined. A majority (88%) required endotracheal intubation and mechanical ventilation and the rest were treated with noninvasive ventilation.

Patients with hypertension were significantly older (66 years vs. 62 years) than their non-hypertension counterparts, the study authors said. The prevalence of hypertension was higher among patients who died in the ICU compared to those discharged from the ICU (63% vs. 40%, respectively), they added.

As of March 25, the investigators said that 58% of the patients in their analysis remained in intensive care, 16% had been discharged from the ICU, and 26% had died in the ICU. ICU mortality was higher in older patients and lower in younger patients and the percentage of patients discharged from the ICU was significantly higher among younger patients vs. older patients (21% vs. 11%, respectively).

The median length of stay in the ICU as of March 25 was 9 days, but ranged from 6 to 13 days, the study authors said. Among 920 patients that remined in the ICU on that date, the median length of stay was 10 days (8-14 days). For patients discharged from the ICU, the median length of stay was 8 days but among patients who died in the ICU the median length of stay was 7 days.

“The volume of critically ill patients with COVID-19 infection that ICUs might be required to manage may be substantial, and adequate ICU capacity to deal with severe respiratory failure should be planned,” the study authors concluded.