Intensive Care Unit Admission for Moderate-to-Severe COVID-19 Patients With Known Cardiovascular Diseases or Their Risk Factors　― Insights From a Nationwide Japanese Cohort Study ―

• Yoshida Naofumi

  Division of Cardiovascular Medicine, Hyogo Prefectural Kakogawa Medical Center Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

• Iwata Sachiyo

  Division of Cardiovascular Medicine, Hyogo Prefectural Kakogawa Medical Center

• Ogawa Masato

  Division of Rehabilitation Medicine, Kobe University Hospital Department of Public Health, Kobe University Graduate School of Health Sciences

• Izawa Kazuhiro P.

  Department of Public Health, Kobe University Graduate School of Health Sciences

• Kuroda Shunsuke

  Department of Cardiology, Kameda Medical Center Department of Cardiovascular Medicine, Cleveland Clinic

• Kohsaka Shun

  Department of Cardiology, Keio University School of Medicine

• Yonetsu Taishi

  Department of Cardiovascular Medicine, Tokyo Medical and Dental University

• Kitai Takeshi

  Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

• Torii Sho

  Department of Cardiology, Tokai University School of Medicine

• Sano Takahide

  Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine Department of Cardiology, Ebara Hospital

• Sakai Yoshitada

  Division of Rehabilitation Medicine, Kobe University Hospital

• Yamashita Tomoya

  Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

• Hirata Ken-ichi

  Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

• Matsue Yuya

  Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine

• Matsumoto Shingo

  Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine

• Node Koichi

  Department of Cardiovascular Medicine, Saga University

Abstract

Background:The COVID-19 pandemic has challenged healthcare systems, at times overwhelming intensive care units (ICUs). We aimed to describe the length and rate of ICU admission, and explore the clinical variables influencing ICU use, for COVID-19 patients with known cardiovascular diseases or their risk factors (CVDRF). Methods and Results:A post hoc analysis was performed of 693 Japanese COVID-19 patients with CVDRF enrolled in the nationwide CLAVIS-COVID registration system between January and May 2020 (mean [±SD] age 68.3±14.9 years; 35% female); 199 patients (28.7%) required ICU management. The mean (±SD) ICU length of stay (LOS) was 19.3±18.5 days, and the rate of in-hospital death and hospital LOS were significantly higher (P<0.001) and longer (P<0.001), respectively, in the ICU than non-ICU group. Logistic regression analysis revealed that clinical variables reflecting impaired general condition (e.g., high C-reactive protein, low Glasgow Coma Scale score, SpO₂, albumin level), male sex, and previous use of β-blockers) were associated with ICU admission (all P<0.001). Notably, age was inversely associated with ICU admission, and this was particularly prominent among elderly patients (OR 0.97, 95% confidence interval 0.95–0.99; P=0.0018). Conclusions:One-third of COVID patients with CVDRF required ICU care during the first phase of the pandemic in Japan. Other than anticipated clinical variables, such as hypoxia and altered mental status, age was inversely associated with the use of the ICU, warranting further investigation.

Journal

• Circulation Reports

  Circulation Reports 3 (7), 375-380, 2021-07-09

  The Japanese Circulation Society

Keywords

• Cardiovascular diseases
• COVID-19
• ICU admission
• ICU length of stay
• Intensive care unit (ICU)

Details

• CRID: 1390851585183952896
• NII Article ID: 130008063925
• DOI: 10.1253/circrep.cr-21-0066
• ISSN: 24340790
• HANDLE: 20.500.14094/0100476962
• Web Site: https://www.jstage.jst.go.jp/article/circrep/3/7/3_CR-21-0066/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2022112632
• Text Lang: en
• Data Source:
  • JaLC
  • IRDB
  • Crossref
  • CiNii Articles
  • KAKEN
• Abstract License Flag: Disallowed