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. 2020 Apr 6;323(16):1574-1581.
doi: 10.1001/jama.2020.5394. Online ahead of print.

Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

Giacomo Grasselli  1   2 Alberto Zangrillo  3   4 Alberto Zanella  1   2 Massimo Antonelli  5   6 Luca Cabrini  7 Antonio Castelli  8 Danilo Cereda  9 Antonio Coluccello  10 Giuseppe Foti  11   12 Roberto Fumagalli  11 Giorgio Iotti  13 Nicola Latronico  14   15 Luca Lorini  16 Stefano Merler  17 Giuseppe Natalini  18 Alessandra Piatti  7 Marco Vito Ranieri  19 Anna Mara Scandroglio  3 Enrico Storti  20 Maurizio Cecconi  21   22 Antonio Pesenti  1   2 COVID-19 Lombardy ICU NetworkAdriana NailescuAlberto CoronaAlberto ZangrilloAlessandro ProttiAndrea AlbertinAndrea Forastieri MolinariAndrea LombardoAngelo PezziAnnalisa BeniniAnna Mara ScandroglioAnnalisa MalaraAntonio CastelliAntonio ColuccelloAntonio MicucciAntonio PesentiAntonello SalaArmando AlborghettiBenvenuto AntoniniCarlo CapraCarmine TroianoClaudio RoscitanoDanilo RadrizzaniDavide ChiumelloDavide CoppiniDavide GuzzonElena CostantiniElena MalpettiElena ZoiaEmanuele CatenaEmiliano AgosteoEnrico BarbaraEnrico BerettaEnrico BoselliEnrico StortiFabiola HarizayFederica Della MuraFerdinando Luca LoriniFrancesco Donato SigurtàFrancesco MarinoFrancesco MojoliFrank RasuloGiacomo GrasselliGiampaolo CasellaGianluca De FilippiGianpaolo CastelliGiorgio AldegheriGiorgio GallioliGiorgio LottiGiovanni AlbanoGiovanni LandoniGiovanni MarinoGiovanni VitaleGiovanni Battista PeregoGiulia EvasiGiuseppe CiterioGiuseppe FotiGiuseppe NataliniGuido MerliIlaria SforziniLeonardo BianciardiLivio CarnevaleLorenzo GrazioliLuca CabriniLuca GuatteriLuca SalviMarco Dei PoliMarco GallettiMarco GemmaMarco RanucciMario RiccioMassimo BorelliMassimo ZambonMatteo SubertMaurizio CecconiMaurizio Giovanni MazzoniMaurizio RaimondiMauro PanigadaMirko BelliatoNicola BronziniNicola LatronicoNicola PetrucciNicolangela BelgiornoPaola TagliabuePaolo CortellazziPaolo GnesinPaolo GrossoPaolo GrittiPaolo PerazzoPaolo SevergniniPatrizia RuggeriPietro SebastianoRemo Daniel CovelloRaquel Fernandez-OlmosRoberto FumagalliRoberto KeimRoberto RonaRoberto ValsecchiSergio CattaneoSergio ColomboSilvia CirriStefano BonazziStefano GrecoStefano MuttiniThomas LangerValentina AlaimoUberto Viola
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Free PMC article

Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

Giacomo Grasselli et al. JAMA. .
Free PMC article

Abstract

Importance: In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.

Objective: To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy.

Design, setting, and participants: Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020.

Exposures: SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs.

Main outcomes and measures: Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network.

Results: Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2O, and Fio2 was greater than 50% in 89% of patients. The median Pao2/Fio2 was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n = 503 aged ≤63 years) and older patients (n = 514 aged ≥64 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2O, respectively; median difference, 0 [95% CI, 0-0]; P = .94). Median Fio2 was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, -10% [95% CI, -14% to 6%]; P = .006), and median Pao2/Fio2 was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, -8 to 22]; P = .02). Patients with hypertension (n = 509) were older than those without hypertension (n = 526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68]; P < .001) and had lower Pao2/Fio2 (median [IQR], 146 [105-214] vs 173 [120-222]; median difference, -27 [95% CI, -42 to -12]; P = .005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n = 786; age ≥64 years) had higher mortality than younger patients (n = 795; age ≤63 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%]; P < .001).

Conclusions and relevance: In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Cecconi reported personal fees from Edwards Lifesciences, from Directed Systems, and from Cheetah Medical outside the submitted work. Dr Grasselli reported personal fees and nonfinancial support from Getinge and from Biotest, personal fees from Thermofisher, grants and personal fees from Fisher&Paykel, and personal fees from Draeger Medical outside the submitted work. Dr Iotti reported personal fees from Hamilton Medical, from Getinge Italia, from Eurosets, from Intersurgical, and from Burke & Burke outside the submitted work. Dr Pesenti reported personal fees from Maquet, from Novalung/Xenios, from Baxter, and from Boehringer Ingelheim outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Distribution of Age and Respiratory Measures on Admission to a COVID-19 Intensive Care Unit
COVID-19 indicates coronavirus disease 2019; PEEP, positive end-expiratory pressure; Fio2, fraction of inspired oxygen; Pao2, arterial partial pressure of oxygen. Boxplots show the 25th, 50th, and 75th percentiles (box); 10th and 90th percentiles (whiskers); and outlying points (circles).

Comment in

  • JAMA. doi: 10.1001/jama.2020.5775

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