Older age, comorbid conditions such as diabetes, malignancy or signs and symptoms such as fatigue, tachycardia, hypoxia are among factors that predispose to critical illness caused by Covid-19, suggests a recent study in the journal PLoS One.

In this retrospective study from Egypt, researchers examined data of 2724 RT PCR-confirmed Covid-19 patients; of these, 423 patients (15.52%) had critical illness. The study was conducted at several centers affiliated to a single health system.

Around 46% of patients with critical Covid-19 were older than 60 years, whereas in the patients with non-critical illness, the percentage of older patients was nearly 40%.

Analysis of data found several factors to be associated with critical illness. Age >60 years (OR = 1.30), low oxygen saturation (OR = 0.93), low Glasgow coma scale (OR = 0.75), diabetes (OR = 1.62), cancer (OR = 2.47) and serum ferritin (OR = 1.004) were found to predict severity of Covid-19. Other factors such as elevated body temperature, tachycardia, leukocytosis, liver injury manifesting as elevated liver enzymes and serum ferritin levels were also found to be significantly associated with an increased risk of critical illness. No significant radiological differences were observed between the critical and non-critical groups in terms of CT findings, including consolidation (3.07% vs. 2.39%), Crazy paving (1.18% vs. 1%), and ground glass opacity (39.95% vs. 44.89%).

Covid-19 has diverse clinical presentations ranging from asymptomatic infection to mild to moderate symptoms to severe disease to critical illness marked by ARDS and multiorgan failure. Risk stratification is essential for early and rapid triaging of patients likely to progress to severe disease. This study has highlighted several factors, including clinical and laboratory parameters, that are predictive of severe Covid-19  and need for intensive care.

 Reference

1. Omran D, et al. Predictors of severity and development of critical illness of Egyptian COVID-19 patients: A multicenter study. PLoS One. 2021 Sep 23;16(9):e0256203.