Mortality Among COVID-19 Patients in the Intensive Care Unit (ICU): A Single-Centre Study from a Malaysian Perspective

PURPOSE: This study investigated the prevalence of mortality among COVID-19 patients admitted to an intensive care unit (ICU) at a single centre hospital in Klang Valley, Selangor, Malaysia. Besides, adverse clinical events (ACE) among COVID-19 patients admitted to ICU who died and were alive were compared, and the factors associated with mortality were explored. METHODS & MATERIALS: Patients admitted to a single centre ICU with polymerase chain reaction (PCR) confirmed of SARS-CoV-2 virus within February 2020-2021 were included in this study. Adverse clinical event (ACE) consists of the presence of pulmonary embolism (PE), deep vein thrombosis (DVT), line-related thrombosis, stroke, myocardial infarction (MI) and peripheral artery disease (PAD) during their ICU admission. A composite of ACE comprised ≥ 1 PE, DVT, line-related thrombosis, stroke, MI and PAD. Mortality is defined as COVID-19 patients who died during ICU admission throughout data collection. RESULTS: Mean (SD) age was 56.6 (13.7) with 63.5% male and 61.6% Malay. Median (IQR) 7 (3-14) days of ICU admission, 64.2%, 53.2 % and 20.9% had underlying hypertension, diabetes, and obesity, respectively. Out of 534 patients included in the study, 122 patients died, with 64.8% developed ≥ 1 ACE compared to 39.1% patients who survived the infection. Higher proportion of deceased patients developed PE (47.5% vs. 34%; p=0.006), MI (16.4% vs. 4.6%; p<0.001), stroke (12.3% vs. 1.5%; p<0.001) and DVT (2.5% vs. 0.2%; p=0.04) than those who survived. Significant predictors of mortality on multivariate logistic regression model include age [OR 1.05 (95% CI 1.03 – 1.07)], length of ICU stay [OR 1.05 (1.02 – 1.07), chronic kidney disease [OR 2.30 (1.32 – 4.01), and presence of ≥ 1 ACE [OR 2.32 (1.45 – 3.72)]. CONCLUSION: The overall mortality of COVID-19 patients admitted to a single centre ICU is high (22.8%), with greater proportion of patients who developed ≥1 ACE. Key factors associated with the mortality were age, length of ICU stays, underlying chronic kidney disease and presence of ≥ 1 ACE. This finding might be helpful to the healthcare providers in the early detection and prevention of ACE associated with mortality among COVID-19 patients admitted to the ICU.