Clinical characteristics, multiorgan dysfunction and outcomes of patients with COVID-19: a prospective case series

Kimia Honarmand; Kyle Fiorini; Debarati Chakraborty; Daniel Gillett; Karishma Desai; Claudio Martin; Karen J. Bosma; Marat Slessarev; Ian M. Ball; Tina Mele; Danielle LeBlanc; Sameer Elsayed; Alejandro Lazo-Langner; Mike J. Nicholson; Robert Arntfield; John Basmaji

doi:10.9778/cmajo.20210151

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Figure 1:
Overview of patient enrolment and disposition. Note: CT = computed tomography, ICU = intensive care unit.

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Table 1:

Baseline characteristics of patients admitted to hospital with COVID-19

Characteristic	No. (%)^*
Characteristic	All patients n = 100	Non-ICU patients n = 68	ICU patients n = 32
Demographic characteristics
Age, yr, median (IQR)	74 (56–83)	76 (60–85)	63 (55–74)
Sex, male	53 (53.0)	34 (50.0)	19 (59.4)
Body mass index, mean ± SD	n = 84 29.2 ± 8.2	n = 56 28.1 ± 7.9	n = 28 31.4 ± 8.5
Preadmission location
Home	66 (66.0)	41 (60.3)	25 (78.1)
Long-term care facility	28 (28.0)	24 (35.3)	4 (12.5)
Retirement home	1 (1.0)	1 (1.5)	0
Other	5 (5.0)	2 (2.9)	3 (9.4)
Comorbidities
Chronic cardiac disease	24 (24)	17 (25.0)	7 (21.9)
Chronic pulmonary disease	17 (17)	14 (20.6)	3 (9.4)
Asthma	15 (15.0)	10 (14.7)	5 (15.6)
Chronic kidney disease	15 (15.0)	10 (14.7)	5 (15.6)
Liver disease	4 (4.0)	2 (2.9)	2 (6.3)
Chronic neurologic disorder	6 (6.0)	5 (7.4)	1 (3.1)
Cancer (active only)	9 (9.0)	7 (10.3)	2 (6.3)
History of cancer (in remission)	8 (8.0)	7 (10.3)	1 (3.1)
Obesity	11 (11.0)	7 (10.3)	4 (12.5)
Diabetes	30 (30.0)	19 (27.9)	11 (34.4)
Dementia (any etiology)	16 (16.0)	15 (22.1)	1 (3.1)
Other comorbidities	7 (7.0)	5 (7.4)	2 (6.3)
Habits
Current smoker	9 (9.0)	7 (10.3)	2 (6.3)
Ex-smoker	28 (28.0)	22 (32.4)	6 (18.8)
Alcohol use (> 14 drinks per week)	4 (4.0)	4 (5.9)	0
Illicit drug use	1 (1.0)	1 (1.5)	0
Exposure history
Contact with confirmed case of SARS-CoV-2 infection	30 (30.0)	23 (33.8)	7 (21.9)
Contact with suspected case of SARS-CoV-2 infection	9 (9.0)	5 (7.4)	4 (12.5)
Travel outside Canada	9 (9.0)	6 (8.8)	3 (9.4)
Travel within Canada	1 (1.0)	0	1 (3.1)

Note: ICU = intensive care unit, IQR = interquartile range, SD = standard deviation.
↵* Unless stated otherwise.

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Table 2:

Clinical characteristics at the time of presentation to hospital

Characteristic	No. (%)^*
Characteristic	All patients n = 100	Non-ICU patients n = 68	ICU patients n = 32
Presenting symptom for > 20% of patients
Cough	71 (71.0)	50 (73.5)	21 (65.6)
Fever	62 (62.0)	37 (54.4)	25 (78.1)
Dyspnea	63 (63.0)	40 (58.8)	23 (71.9)
Fatigue	51 (51.0)	35 (51.5)	16 (50.0)
Diarrhea	32 (32.0)	23 (33.8)	9 (28.1)
Myalgia	25 (25.0)	13 (19.1)	12 (37.5)
Headache	23 (23.0)	13 (19.1)	10 (31.3)
Vital signs at hospital presentation
Temperature > 38°C	36/98 (36.7)	19/67 (28.4)	17/31 (54.8)
Heart rate > 100 beats/min	31/96 (32.3)	18/66 (27.3)	13/30 (43.3)
Systolic blood pressure < 90 mm Hg	3/98 (3.1)	2/67 (3.0)	1/30 (3.3)
Respiratory rate > 24 breaths/min	42/95 (44.2)	23/67 (34.3)	19/28 (67.9)
Oxygen saturation < 92%	20/98 (20.4)	8/67 (11.9)	12/31 (38.7)
Supplemental oxygen therapy at clinical presentation	35/99 (35.4)	18/67 (26.9)	17/32 (53.1)
Laboratory results at hospital presentation, mean ± SD
Leukocyte count, ×10⁹/L	10.6 ± 13.2	11.0 ± 15.4	10.0 ± 6.1
Lymphocyte count, ×10⁹/L	3.3 ± 12.9	4.2 ± 15.5	1.3 ± 1.3
Creatinine, μmol/L	110.5 ± 80.1	106.9 ± 62.6	118.5 ± 110.8
LDH, U/L	416.3 ± 253.0	367.4 ± 177.5	563.0 ± 391.1
Ferritin, μg/L	1702.6 ± 2154.4	1772.1 ± 2372.3	1424.4 ± 998.2
CRP, mg/L	97.6 ± 83.5	87.9 ± 75.8	126.8 ± 101.9
d-dimer, μg/L	1198.9 ± 1311.5	956.0 ± 789.4	1603.7 ± 2093.1
Troponin, ng/L	31.8 ± 42.1	36.3 ± 46.8	18.1 ± 17.5
Fibrinogen, g/L	7.5 ± 0.5	7.4 ± 0.7	–^†
pH on blood gas	7.4 ± 0.1	7.4 ± 0.1	7.4 ± 0.1

Note: CRP = C-reactive protein, ICU = intensive care unit, LDH = lactate dehydrogenase, SD = standard deviation.
↵* Unless stated otherwise.
↵† One data point only.

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Table 3:

Pulmonary complications and management among patients hospitalized with COVID-19

Complications and management	No. (%)^*
Complications and management	All patients n = 100	Non-ICU patients n = 68	ICU patients n = 32
Clinical parameters
PF ratio < 150 mm Hg	NA	NA	27/32 (84.4)
Duration of PF ratio < 150 mm Hg, d, median (IQR)	NA	NA	8 (4–15)
CT chest findings^†
Localized ground-glass opacities	4/26 (15.4)	3/12 (25)	1/14 (7.1)
Diffuse ground-glass opacities	14/26 (53.8)	5/12 (41.7)	9/14 (64.3)
Unilateral consolidation or infiltration	2/26 (7.7)	1/12 (8.3)	1/14 (7.1)
Bilateral consolidation or infiltration	14/26 (53.8)	7/12 (58.3)	7/14 (50.0)
Unilateral pleural effusion	2/26 (7.7)	0/12 (0)	2/14 (14.3)
Bilateral pleural effusion	3/26 (11.5)	2/12 (16.7)	1/14 (7.1)
Emphysematous changes or bronchiectasis	4/26 (15.4)	2/12 (16.7)	2/14 (14.3)
Scarring or fibrosis	4/26 (15.4)	0/12 (0)	4/14 (28.6)
Organizing pneumonia pattern	2/26 (7.7)	1/12 (8.3)	1/14 (7.1)
Lung ultrasonography findings^‡
Irregular pleural line	26/30 (86.7)	5/7 (71.4)	21/23 (91.3)
Alveolar-interstitial syndrome (B-lines)	28/30 (93.3)	5/7 (71.4)	23/23 (100)
Consolidation	12/30 (40)	0/6 (0)	12/24 (50.0)
Unilateral	2/12 (16.7)	0/6 (0)	2/12 (16.7)
Bilateral	10/12 (83.3)	0/6 (0)	10/12 (83.3)
Moderate–large pleural effusion	2/30 (6.7)	0/7 (0)	2/23 (8.7)
Respiratory therapies
Received oxygen therapy	79/100 (79.0)	47/68 (69.1)	32/32 (100.0)
High-flow nasal cannula	23/100 (23.0)	5/68 (7.4)	18/32 (56.3)
Noninvasive ventilation	9/100 (9.0)	1/68 (1.5)	8/32 (25.0)
Invasive ventilation	24/100 (24.0)	0/68 (0)	24/32 (75.0)
Duration of invasive and noninvasive ventilation in ICU, d, median (IQR)	NA	NA	n = 27 14 (10–22)
Prone positioning	17/98 (17.3)	4/68 (5.9)	13/30 (43.3)
Neuromuscular blocking agents	NA	NA	18/32 (56.3)
Steroids for respiratory failure	8/100 (8.0)	4/68 (5.9)	4/32 (12.5)
VV-ECMO	NA	NA	2/32 (6.3)

Note: CT = computed tomography, ICU = intensive care unit, IQR = interquartile range, NA = not applicable, PF ratio = Pao₂/Fio₂ ratio, VV-ECMO = venovenous extracorporeal membrane oxygenation.
↵* Unless stated otherwise.
↵† Results reflect CT done during hospitalization.
↵‡ Results reflect lung ultrasonography done during hospitalization.

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Table 4:

Extrapulmonary complications among patients hospitalized with COVID-19

Complications and management	No. (%)^*
Complications and management	All patients n = 100	Non-ICU patients n = 68	ICU patients n = 32
Neurologic complications
Ischemic stroke	3/26 (11.5)	1/10 (10.0)	2/16 (12.5)
Intracranial hemorrhage	6/26 (23.1)	0	6/16 (37.5)
Thrombotic complications and therapies
Deep venous thrombosis on ultrasonography	2/13 (15.4)	0	2/9 (22.2)
Pulmonary embolism on CTPA	6/26 (23.1)	3/12 (25.0)	3/14 (21.4)
Received therapeutic anticoagulation	11/100 (11.0)	3/68 (4.4)	8/32 (25.0)
Started for presumed hypercoagulable state from COVID-19	3/100 (3.0)	0	3/32 (9.4)
Started for confirmed venous thromboembolism	7/100 (7.0)	3/68 (4.4)	4/32 (12.5)
Started for VV-ECMO circuit	1/100 (1.0)	0	1/32 (3.1)
Cardiac and hemodynamic complications and therapies
Received vasopressors or inotropes	NA	NA	24/32 (75.0)
Duration of vasopressors or inotropes, d, median (IQR)	NA	NA	n = 24 9 (3.75–11.75)
Corticosteroids for hemodynamic shock	4/100 (4.0)	0	4/32 (12.5)
Echocardiography findings^†
Depressed LVEF (30%–50%)	2/29 (6.9)	0/5 (0)	2/24 (8.3)
Severely depressed LVEF (< 30%)	2/29 (6.9)	1/5 (20.0)	1/24 (4.2)
Reduced RV systolic function	5/29 (17.2)	1/5 (20.0)	3/24 (12.5)
Pulmonary hypertension	9/29 (31.0)	2/5 (40.0)	7/24 (29.2)
Pericardial effusion	1/29 (3.4)	0/5 (0)	1/24 (4.2)
Renal complications and therapies
Acute kidney injury^‡	27/100 (27.0)	11/68 (16.2)	16/32 (50.0)
Received CRRT	NA	NA	5/32 (15.6)
Duration of CRRT, median (IQR)	NA	NA	4 (2.0–6.5)
Highest AKIN stage
Stage I	16/100 (16.0)	9/68 (13.2)	7/32 (21.9)
Stage II	5/100 (5.0)	0	5/32 (15.6)
Stage III	6/100 (6.0)	2/68 (2.9)	4/32 (12.5)
Secondary infections
Positive respiratory culture (bacterial or fungal)	13/100 (13.0)	0	13/32 (40.6)
Positive blood culture	8/100 (8.0)	2/68 (2.9)	6/32 (18.8)
Positive urine culture	15/100 (15.0)	4/68 (5.9)	11/32 (34.4)
Clostridioides difficile	1/100 (1.0)	1/68 (1.5)	0

Note: AKIN = Acute Kidney Injury Network, CTPA = computed tomography pulmonary angiography, CRRT = continuous renal replacement therapy, ICU = intensive care unit, IQR = interquartile range, LVEF = left ventricular ejection fraction, NA = not applicable, RV = right ventricular, SD = standard deviation, VV-ECMO = venovenous extracorporeal membrane oxygenation.
↵* Unless stated otherwise.
↵† Results reflect echocardiography done during hospitalization.
↵‡ Defined by criteria of the Acute Kidney Injury Network.10

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Table 5:

Outcomes of patients hospitalized with COVID-19 after hospital discharge

Outcome	No. (%)
Outcome	All patients n = 100	Non-ICU patients n = 68	ICU patients n = 32
Vital status
28-day mortality	28 (28.0)	15 (22.1)	13 (40.6)
Hospital mortality	34 (34.0)	20 (29.4)	14 (43.8)
Disposition among survivors
Another acute care facility	2/66 (3.0)	0/48 (0)	2/18 (11.1)
Rehabilitation centre	12/66 (18.2)	8/48 (16.7)	4/18 (22.2)
Home	47/66 (71.2)	35/48 (72.9)	12/18 (66.7)
Long-term care facility	5/66 (7.6)	5/48 (10.4)	0/18 (0)
CT thorax findings after hospital discharge
Ground-glass opacities	5/19 (26.3)	3/11 (27.3)	2/8 (25.0)
Emphysematous changes or bronchiectasis	6/19 (31.6)	2/11 (18.2)	4/8 (50.0)
Scarring or fibrosis	5/19 (26.3)	0/11 (0)	5/8 (62.5)
Echocardiography findings after hospital discharge
Depressed LVEF (30%–50%)	1/15 (6.7)	1/10 (10.0)	0/5 (0)
Reduced RV systolic function	2/15 (13.3)	2/10 (20.0)	0/5 (0)
RV dilatation	5/15 (33.3)	3/10 (30.0)	2/5 (40.0)