Treatment of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the intensive care unit, Department of anesthesiology, resuscitation and intensive care, University Hospital of Split during 2020

Cilj istraživanja: Cilj istraživanja je prikazati smrtnost bolesnika liječenih zbog SARS-CoV-2 infekcije u JIM-u Klinike za anesteziologiju, reanimatologiju i intenzivno liječenje KBC-a Split tijekom 2020. godine te koji su komorbiditeti i komplikacije tijekom liječenja povezani sa smrtnim ishodom. Materijali i metode: Podaci za ovo istraživanje prikupljeni su analizom povijesti bolesti i otpusnih pisama bolesnika iz arhive Klinike za anesteziologiju, reanimatologiju i intenzivno liječenje te Klinike za infektologiju KBC-a Split. U studiju su uključeni svi bolesnici zaprimljeni u JIM-u s pozitivnim PCR testom na SARS-CoV-2 virus tijekom 2020. godine. Prikupljeni su demografski podaci o dobi i spolu. Od komorbiditeta analizirani su: šećerna bolest, kronične plućne bolesti, hipertenzija, kardiovaskularne bolesti, smanjena funkcija bubrega i jetre. Uz navedeno, evidentirano je postojanje: pretilosti, prethodne pneumonije, astme te postojanje imunosupresivne i/ili onkološke terapije. Od intrahospitalnih komplikacija zabilježeno je sljedeće: respiratorno zatajenje, akutno bubrežno zatajenje, plućna embolija, superinfekcija, SIRS, pneumotoraks te od kardioloških komplikacija poremećaji ritma i srčano zatajenje. Statistička povezanost navedenih podležećih stanja i bolesti te intrahospitanih komplikacija sa smrtnim ishodom ispitivana je hi kvadrat testom, Mann-Whitney testom, Kolmogorov-Smirnovim testom i logističkom regresijom na razini značajnosti P < 0,05. Rezultati: U istraživanje je uključeno 185 bolesnika, od kojih 141 (76%) muškarac, a 44 (24%) žene. Medijan životne dobi je 71 godina, bez statistički značajne razlike između spolova. Povezanost sa smrtnim ishodom dokazana je sa životnom dobi, stupnjem bubrežne funkcije i brojem kardiovaskularnih bolesti. Također postoji statistički značajna povezanost mortaliteta s nastupom respiratornog i bubrežnog zatajenja. Od komplikacija koje su prethodile smrtnom ishodu zabilježene su: hemodinamska nestabilnost (32,8%), akutno bubrežno zatajenje (24,1%), septičko stanje (20,7%) i pogoršanje parametara ventilacije (6,9%). Medijan dana provedenih u JIM-u iznosi 8 dana. Od ukupnog broja bolesnika njih 69 (37%) premješteno je s JIM-a na druge odjele, a 116 (63%) završilo je sa smrtnim ishodom, što daje stopu smrtnosti od 63% za bolesnike liječene u JIM-u KBC-a Split tijekom 2020. godine. Zaključak: Smrtnost bolesnika liječenih u JIM-u KBC-a Split zbog SARS-CoV-2 infekcije je 63%. Ljudi starije životne dobi, sa smanjenom bubrežnom funkcijom i s postojanjem kardiovaskularne bolesti pod povećanim su rizikom za razvoj smrtnog ishoda. Potreba za mehaničkom ventilacijom i nastup akutnog bubrežnog zatajenja tijekom intrahospitalnog liječenja ominozni su znak za krajnji ishod COVID-19 bolesti.Objectives: The study aims to determine the mortality rate of patients treated with SARS-CoV-2 infection in the intensive care unit, Department of anesthesiology, resuscitation and intensive care, University Hospital of Split during 2020. and which comorbidities and intrahospital complications are related to a lethal outcome. Material and methods: Data for this study are collected by analyzing patient's history and discharge letters taken from the archive of the Department of anesthesiology, resuscitation and intensive care and Department of infectology, University Hospital of Split. All patients who have been admitted to the ICU during 2020. with previously positive PCR SARS-CoV-2 test are included in the study. Demographic data, such as age and gender, were colleted. The analyzed comorbidities are: diabetes mellitus, chronic lung disease, hypertension, cardiovascular disease, renal and liver damage. Additional information gathered are: previous pneumonia, obesity, asthma and immunosuppressive and/or oncological therapy. Intrahospital complications that have been collected are: respiratory failure, acute kidney failure, pulmonary embolism, superinfection, SIRS, pneumotorax, arrhythmia and heart failure. The statistical relationship of previously listed comorbidities, conditions and intrahospital complications with a lethal outcome is tested by Chi-square test, Mann-Whitney test, Kolmogorov-Smirnov test and logistic regression with the statistical significance P < 0.05. Results: In total, 185 patiens are included, from whom 141 (76%) are men, and 44 (24%) are women. Median age is 71 years without statistically significant differences between the sexes. Conditions related to a lethal outcome are: older age, decreased kidney function and the number of cardiovascular disease. Also, there is a statistically significant correlation between mortality rate and respiratory and acute kidney failure. Complications that precede lethal outcome are: hemodynamic instability (32.8%), acute kidney injury (24.1%), septic shock (20.7%) and worsening of respiratory parameters (6.9%). The median length of ICU treatment is 8 days. 37% (69) of all patiens are discharge from ICU, while 63% (116) dies, which gives a mortality rate of 63% for COVID-19 patiens treated in the intensive care unit of University Hospital of Split during 2020. Conclusion: The mortality rate of COVID-19 patiens treated in the intensive care unit of University Hospital od Split is 63%. Elderly patients with decreased kidney function and cardiovascular disease are at higher risk for a lethal outcome. Mechanically ventilated patients and those with acute renal failure during intrahospital treatment have a higher mortality risk