Associations of complications with admission to ICU
| Complications | Admission | P value | ||
|---|---|---|---|---|
| General ward (N= 94) | ICU (N= 19) | |||
| Acute kidney injury | 0.003 | |||
| Yes | 1 (20%) | 4 (80%) | ||
| No | 93 (86.1%) | 15 (13.9%) | ||
| Liver injury | <0.001 | |||
| Yes | 0 (0%) | 5 (100%) | ||
| No | 94 (87.0%) | 14 (13.0%) | ||
| Sepsis | 0.001 | |||
| Yes | 0 (0%) | 4 (100%) | ||
| No | 94 (86.2%) | 15 (13.8%) | ||
| Gestational hypertension | 0.033 | |||
| Yes | 2 (40%) | 3 (60%) | ||
| No | 92 (85.2%) | 16 (14.8%) | ||
| Preeclampsia | 0.526 | |||
| Yes | 3 (75%) | 1 (25%) | ||
| No | 91 (83.5%) | 18 (16.5%) | ||
| Eclampsia | 1.000 | |||
| Yes | 1 (100%) | 0 (0%) | ||
| No | 93 (83.0%) | 19 (17.0%) | ||
Hemodynamic status in the ICU
| Variables | Outcomes | OR (95% CI) | P value | ||
|---|---|---|---|---|---|
| Improvement (N = 11) | Death (N = 8) | ||||
| Hemodynamic status | |||||
| Arterial line inserted | 0.633 | ||||
| Yes | 6 (50%) | 6 (50%) | 0.400 (0.055–2.933) | ||
| No | 5 (71.4%) | 2 (28.6%) | 1.000 | ||
| Echocardiography (N = 13) | |||||
| Dimension | 1.000 | ||||
| Abnormal | 4 (44.4%) | 5 (55.6%) | 0.800 (0.076–8.474) | ||
| Normal | 2 (50%) | 2 (50%) | 1.000 | ||
| Ejection fraction | 1.000 | ||||
| <55% | 0 (0%) | 1 (100%) | N/A | ||
| ≥55% | 6 (50%) | 6 (50%) | N/A | ||
| TAPSE (N=11) | N/A | ||||
| ≤16 | 0 | 0 | |||
| >16 | 5 (45.5%) | 6 (54.5%) | |||
| Diastolic dysfunction | 1.000 | ||||
| Yes | 1 (33.3%) | 2 (66.7%) | 0.500 (0.034–7.452) | ||
| No | 5 (50%) | 5 (50%) | 1.000 | ||
| Valve abnormality (N=12) | 1.000 | ||||
| Yes | 4 (44.4%) | 5 (55.6%) | 0.800 (0.076–8.474) | ||
| No | 1 (33.3%) | 2 (66.7%) | 1.000 | ||
| Pericardial effusion | 1.000 | ||||
| Yes | 0 (0%) | 1 (100%) | N/A | ||
| No | 6 (50%) | 6 (50%) | N/A | ||
| Any vasopressor | 0.003 | ||||
| Yes | 3 (27.3%) | 8 (72.7%) | N/A | ||
| No | 8 (100%) | 0 (0%) | N/A | ||
| Any antiarrhythmic | 0.005 | ||||
| Yes | 2 (22.2%) | 7 (77.8%) | 0.032 (0.002–0.426) | ||
| No | 9 (90%) | 1 (10%) | 1.000 | ||
Laboratory findings on patients' clinical outcomes
| Laboratory parameters | Reference Values | Pregnancy Effect | Outcomes | P Value | |
|---|---|---|---|---|---|
| Improvement (N = 11) | Death (N = 8) | ||||
| Haemoglobin | 12.0 – 15.0 g/dL | 1.4 – 2.0 g/dL decrease | 10.10±1.54 | 9.63±1.84 | 0.549 |
| Leukocytes | 4.0 – 10.0 x 103/μL | 3.5 x 103/μL increase | 13.51 (5.20–46.34) | 33.03 (6.17–67.30) | 0.032 |
| Thrombocytes | 150 – 410 x 103/μL | Slight decrease | 248.74±149.46 | 210.00±149.57 | 0.584 |
| D-Dimer | < 500.0 ng/mL | 130 – 170 ng/mL | 3107.46±2021.33 | 4248.74±2705.49 | 0.320 |
| C-reactive protein | <5.0 mg/L | 0.4 – 8.1 mg/L | 83.71±67.60 | 148.03±40.38 | 0.031 |
| Procalcitonin | <0.05 ng/mL | - | 0.20 (0.20–0.74) | 0.70 (0.20–7.13) | 0.074 |
| SGOT | 0 – 31 U/L | - | 36.00 (17.00–230.00) | 63.00 (37.00–309.00) | 0.028 |
| SGPT | 0 – 31 U/L | - | 36.50 (12.00–230.00) | 31.00 (22.00–379.00) | 0.770 |
| Albumin | 3.2 – 4.6 g/dL | 1 g/dL decrease | 3.31±0.53 | 3.08±0.33 | 0.434 |
| Urea | 15 –40 mg/dL | 50% decrease | 22.00 (12.00–141.00) | 66.00 (14.00–243.00) | 0.126 |
| Serum creatinine | 0.50 –1.00 mg/dL | - | 0.57 (0.41–1.38) | 1.12 (0.56–7.99) | 0.026 |
| Arterial blood gas | |||||
| pH | 7.350 – 7.450 | - | 7.36±0.10 | 7.13±0.17 | 0.019 |
| pO2 | 75.00 – 100.00 | - | 80.70 (56.00–268.00) | 68.25 (57.50–118.40) | 0.307 |
| pCO2 | 35.00 – 45.00 | 25.00 – 33.00 | 38.70±9.06 | 59.67±13.53 | 0.007 |
| P/F Ratio | >300 | - | 127.09 (70–382.86) | 68.25 (57.50–118.40) | 0.006 |
Criteria of adult COVID-19 severity classification according to the Indonesian COVID-19 Management Guidelines
| Severity Level | Criteria |
|---|---|
| Mild | No evidence of pneumonia or hypoxia. |
| Symptoms are limited to fever, cough, fatigue, anorexia, shortness of breath, myalgia, and/or other non-specific | |
| symptoms such as sore throat, nasal congestion, headache, diarrhea, nausea and vomiting, anosmia, or ageusia. | |
| SpO2 > 95% on room air. | |
| Moderate | Clinical signs of pneumonia (fever, cough, dyspnea, tachypnea) with no sign of severe pneumonia. |
| SpO2 ≥ 93% on room air. | |
| Severe | Clinical signs of pneumonia (fever, cough, dyspnea, tachypnea) with at least one of the following: Respiratory rate > 30 breaths per minute, severe respiratory distress, and/or SpO2 < 93% on room air. |
| Critical | Patients with acute respiratory distress syndrome, sepsis and septic shock, or other conditions requiring external life support such as mechanical ventilation or vasopressor therapy. |
Oxygenation support in the ICU
| Variables | Outcome | OR (95% CI) | P value | |
|---|---|---|---|---|
| Improvement (N = 11) | Death (N = 8) | |||
| Baseline Respiratory Status | ||||
| Oxygenation therapy at ICU admission | 0.014 | |||
| Simple mask | 2 (100%) | 0 (0%) | N/A | |
| Non-rebreathing mask | 0 (0%) | 1 (100%) | N/A | |
| HFNC | 7 (70%) | 3 (30%) | N/A | |
| NIV | 2 (100%) | 0 (0%) | N/A | |
| Ventilator | 0 (0%) | 4 (100%) | N/A | |
| Oxygen saturation levels at admission to the hospital | 95.45±3.05 | 82.63±12.99 | N/A | 0.027 |
| Chest X-ray | 0.013 | |||
| Bilateral infiltrate >50% | 4 (33.3%) | 8 (66.7%) | N/A | |
| Bilateral infiltrate <50% | 7 (100%) | 0 (0%) | N/A | |
| Mechanical Ventilation | ||||
| NIV (N = 8) | 3 (37.5%) | 5 (62.5%) | 0.516 (0.916–1.353) | 0.181 |
| Invasive ventilators (N= 9) | 1 (11.1%) | 8 (88.9%) | N/A | <0.001 |
| Intubation timing | <0.001 | |||
| ER admission | 0 (0%) | 4 (100%) | N/A | |
| Day 1–2 in ICU | 1 (50%) | 1 (50%) | N/A | |
| ≥ Day 3 in ICU | 0 (0%) | 3 (100%) | N/A | |
| Days on ventilator support | 7 | 6.63+3.02 | N/A | N/A |
| Pneumothorax on ventilator | 0 (0%) | 1(100%) | N/A | 0.421 |
| Prone positioning | 1.000 | |||
| Yes | 4 (57.1%) | 3 (42.9%) | 0.952 (0.144–6.281) | |
| No | 7 (58.3%) | 5 (41.7%) | 1.000 | |
Treatments in the ICU
| Treatment | Outcomes | OR (95% CI) | P | |
|---|---|---|---|---|
| Improvement (N = 11) | Death (N = 8) | |||
| Kidney replacement | 0.031 | |||
| Hemodialysis | 0 (0%) | 2 (100%) | N/A | |
| CRRT | 0 (0%) | 2 (100%) | N/A | |
| No | 11 (73.3%) | 4 (26.7%) | N/A | |
| Any analgetic-sedation | <0.001 | |||
| None given | 8 (100%) | 0 (0%) | N/A | |
| 1–3 medications | 3 (60%) | 2 (40%) | N/A | |
| >3 medications | 0 (0%) | 6 (100%) | N/A | |
| Antiviral | 0.444 | |||
| Remdesivir | 10 (58.8%) | 7 (41.2%) | N/A | |
| Remdesivir and Oseltamivir | 0 (0%) | 1 (100%) | N/A | |
| Corticosteroid | 0.251 | |||
| Dexamethasone | 7 (63.6%) | 4 (36.4%) | N/A | |
| Methylprednisolone | 0 (0%) | 3 (100%) | N/A | |
| Both | 2 (66.7%) | 1 (33.3%) | N/A | |
| Anticoagulant | 0.546 | |||
| Yes | 10 (62.5%) | 6 (37.5%) | 3.333 (0.246–45.109) | |
| No | 1 (33.3%) | 2 (66.7%) | 1.000 | |
| Tocilizumab (Actemra) | 0.319 | |||
| Yes | 2 (33.3%) | 4 (66.7%) | 0.222 (0.028–1.754) | |
| No | 9 (69.2%) | 4 (30.8%) | 1.000 | |
| Intravenous immunoglobulin | 0.421 | |||
| Yes | 0 (0%) | 1 (100%) | N/A | |
| No | 11 (61.1%) | 7 (28.9%) | N/A | |
| Convalescent plasma | 0.319 | |||
| Yes | 2 (33.3%) | 4 (66.7%) | 0.222 (0.028–1.754) | |
| No | 9 (69.2%) | 4 (30.8%) | 1.000 | |
Baseline characteristics of maternal COVID-19 patients in ICU
| Characteristics | Outcomes | P value | ||
|---|---|---|---|---|
| Improvement (N=11) | Death (N=8) | |||
| Age (years) | 34±5 | 34±3 | 0.911 | |
| Gestational age (weeks) | 30 (22–41) | 32 (5–38) | 0.901 | |
| Pregnancy status at admission | 1.000 | |||
| Pregnant | 8 (61.5%) | 5 (38.5%) | ||
| Post delivery | 3 (50%) | 3 (50%) | ||
| COVID-19 severity | 0.048 | |||
| Mild | 2 (100%) | 0 (0%) | ||
| Severe | 7 (77.8%) | 2 (22.2%) | ||
| Critical | 2 (25%) | 6 (75%) | ||
| Length of stay (days) | 9 (1–31) | 10 (2–13) | 0.901 | |
| Comorbidities | ||||
| Nasopharyngeal cancer | 0.421 | |||
| Yes | 0 (0%) | 1 (100%) | ||
| No | 11 (61.1%) | 7 (38.9%) | ||
| Congestive heart failure | 0.546 | |||
| Yes | 1 (33.3%) | 2 (66.7%) | ||
| No | 10 (62.5%) | 6 (37.5%) | ||
| Coronary artery disease | 0.421 | |||
| Yes | 0 (0%) | 1 (100%) | ||
| No | 11 (61.1%) | 7 (38.9%) | ||
| Chronic hypertension | 0.421 | |||
| Yes | 0 (0%) | 1 (100%) | ||
| No | 11 (61.1%) | 7 (38.9%) | ||
| Obesity | 0.164 | |||
| Yes | 0 (0%) | 2 (100%) | ||
| No | 11 (64.7%) | 6 (35.3%) | ||
| Asthma | 1.000 | |||
| Yes | 1 (100%) | 0 (0%) | ||
| No | 10 (55.6%) | 8 (44.4%) | ||
| Type-2 diabetes mellitus | 1.000 | |||
| Yes | 2 (66.7%) | 1 (33.3%) | ||
| No | 9 (56.2%) | 7 (43.4%) | ||
| Tuberculous lymphadenitis | 1.000 | |||
| Yes | 1 (100%) | 0 (0%) | ||
| No | 10 (55.6%) | 8 (44.4%) | ||
The Association between Comorbidities and Outcomes
| Comorbidity | Outcomes | P value | |
|---|---|---|---|
| Improvement (N=11) | Death (N=8) | ||
| At least 1 | 15 (78.9%) | 4 (21.1%) | 0.026 |
| None | 90 (95.7%) | 4 (4.3%) | |