Elsevier

Mayo Clinic Proceedings

Volume 96, Issue 1, January 2021, Pages 183-202
Mayo Clinic Proceedings

Review
Clinical Characteristics, Treatment, and Outcomes of Critically Ill Patients With COVID-19: A Scoping Review

https://doi.org/10.1016/j.mayocp.2020.10.022Get rights and content

Abstract

A growing number of studies on coronavirus disease 2019 (COVID-19) are becoming available, but a synthesis of available data focusing on the critically ill population has not been conducted. We performed a scoping review to synthesize clinical characteristics, treatment, and clinical outcomes among critically ill patients with COVID-19. Between January 1, 2020, and May 15, 2020, we identified high-quality clinical studies describing critically ill patients with a sample size of greater than 20 patients by performing daily searches of the World Health Organization and LitCovid databases on COVID-19. Two reviewers independently reviewed all abstracts (2785 unique articles), full text (218 articles), and abstracted data (92 studies). The 92 studies included 61 from Asia, 16 from Europe, 10 from North and South America, and 5 multinational studies. Notable similarities among critically ill populations across all regions included a higher proportion of older males infected and with severe illness, high frequency of comorbidities (hypertension, diabetes, and cardiovascular disease), abnormal chest imaging findings, and death secondary to respiratory failure. Differences in regions included newly identified complications (eg, pulmonary embolism) and epidemiological risk factors (eg, obesity), less chest computed tomography performed, and increased use of invasive mechanical ventilation (70% to 100% vs 15% to 47% of intensive care unit patients) in Europe and the United States compared with Asia. Future research directions should include proof-of-mechanism studies to better understand organ injuries and large-scale collaborative clinical studies to evaluate the efficacy and safety of antivirals, antibiotics, interleukin 6 receptor blockers, and interferon. The current established predictive models require further verification in other regions outside China.

Section snippets

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist in reporting findings.15

Literature Characteristics

The literature search generated 3172 records. Of these, 387 were duplicates and 2567 were excluded. A full-text review was conducted on 218 studies, and 127 were excluded because they did not meet our criteria. One additional relevant RCT study was included for data synthesis. A total of 92 studies were included for data abstraction (Figure).

Characteristics of Included Studies

Table 1 summarizes the main characteristics of the 92 included studies, 54 (59%) of which were original articles and 35 (38%) were research letters. Study

Discussion

In this scoping review, we synthesized the emerging global evidence on critically ill patients with COVID-19, specifically clinical characteristics, treatment, and risk factors associated with poor prognosis. This review aimed to provide insights for effective management of severe COVID-19 and identify gaps in knowledge to guide future research. Some clinical findings were similar for all regions—for example, the frequency of ARDS. However, some of the findings differed by region, likely due to

Conclusion

In this scoping review, we assessed the current evidence related to critically ill patients with COVID-19 to summarize the clinical manifestations, management, and risk factors associated with poor prognosis to inform clinicians and identify future research directions. Some early clinical research findings from China and Europe can be applied to US practice; however, there are notable differences in coexisting chronic disease, complications, and intervention strategies geographically as well as

Acknowledgments

We thank Danielle J. Gerberi, a librarian working at Mayo Clinic, Rochester, Minnesota, for her guidance about relevant databases and literature searching strategies and Drs Ognjen Gajic and Vitaly Herasevich for their critical review of and comments on the submitted manuscript.

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    Grant Support: This work was supported in part by grant R18HS026609 from the Agency for Healthcare Research and Quality and by a Discovery Grant from the Society of Critical Care Medicine.

    Potential Competing Interests: Dr Pickering has received fees for board membership, has patents (planned, pending, or issued, funds paid to his institution), has received royalties, and has stock/stock options (all not related to the current work) from Ambient Clinical Analytics. The other authors report no competing interests.

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