Clinical features and predictors of severity in COVID-19 patients with critical illness in Singapore
Ser Hon Puah, Barnaby Edward Young, Po Ying Chia, Vui Kian Ho, Jiashen Loh, Roshni Sadashiv Gokhale, Seow Yen Tan, Duu Wen Sewa, Shirin Kalimuddin, Chee Keat Tan, Surinder Pada, Matthew E. Cove, Louis Yi Ann Chai, Purnima Parthasarathy, Benjamin Ho, Jensen Ng, Li Min Ling, John Abisheganaden, Vernon J. M. Lee, Cher Heng Tan, Raymond T. P. Lin, Yee‐Sin Leo, David Chien Lye, Tsin Wen Yeo, Poh Lian Lim, Brenda Ang, Cheng Chuan Lee, Lawrence S. Lee, Oon Tek Ng, Mónica Chan, Kalisvar Marimuthu, Shawn Vasoo, Chen Seong Wong, Tau Hong Lee, Sapna P. Sadarangani, Ray Junhao Lin, Mucheli Sharavan Sadasiv, Deborah Hee Ling Ng, Chiaw Yee Choy, Glorijoy Shi En Tan, Yu Tan, Sean Wei Xiang Ong, Stephanie Sutjipto, Pei Hua Lee, Jun Yang Tay, Ding Ying, Bo Yan Khoo, Woo Chiao Tay, Gabrielle Ng, Yun Yuan Mah, Wilnard Tan, Sennen Jin Wen Lew, Raymond Fong, Helen May Lin Oh, Jaime Mei Fong Chien, Humaira Shafi, Hau Yiang Cheong, Darren Cheng Han Teo, Thuan Tong Tan, Ban Hock Tan, Jenny G. Low, Limin Wijaya, Indumathi Venkatachalam, Ying Ying Chua, Benjamin Pei Zhi Cherng, Yvonne Fu Zi Chan, Ghee Chee Phua, Ken Junyang Goh, Jade Xiao Jue Soh, Shuwei Zheng, Pushpalatha Bangalore Lingegowda, Wee Ming Peh, Yi Lin Lee, Jun Yang Ho, April Yu Jie Chia, Li Lin, Say Tat Ooi, Tambyah Paul Anantharajah, Jyoti Somani, Jolene Oon, Gabriel Yan
Abstract
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.