Epidemiological Study of Patients Admitted in Intensive Care Unit with Severe Acute Respiratory Illness with a Possible Diagnosis of COVID19 (EPIC19), a Multicentre Study.

BackgroundGlobal pandemic of COVID 19 has affected many countries. The initial epicenter was in China with gradual spread to various countries including India.For a developing country like India with limited resources and high population, it is worthwhile to know how these patients requiring intensive care admission were managed and the outcome of these patients. To address these issues, a prospective observational study was planned.Methods A multicenter study was conducted from June 2020 to December 2020 including 4 centers across India. Patients > 18 years of age admitted in the intensive care unit (ICU), with the diagnosis of COVID 19 pneumonia confirmed by reverse transcriptase –polymerase chain reaction (RT-PCR) or rapid antigen test (RAT) as applicable were included. Factors associated with ICU mortality were examined using multivariable logistic regression analysis and Cox proportional hazard model. ResultsOf 667 patients were included in the study. ICU mortality was 60 %. In multivariable analysis, history of cerebral vascular accident (CVA), day 1 acute physiology and chronic health evaluation (APACHE II) score, need for invasive ventilator support, minimum PO2, fluid balance and complications such as pneumothorax and arrhythmia during ICU admission were associated with mortality. Among these parameters, day 1 need for invasive ventilator support (odds ratio OR: 3.01(1.81, 5.00) and development of arrhythmia (OR 3.85 [1.56, 8.06]) had higher odds of mortality. Cox proportional hazard analysis showed, history of ischemic heart disease (IHD) (Hazard Ratio, HR 1.64, 95% CI:1.13, 2.38), day1 APACHE II (HR 1.03, 95% CI:1.00, 1.07), arterial blood gas (ABG) pH (HR 0.14, 95% CI:0.03, 0.56) and use of therapeutic anticoagulation (HR 0.42,95% CI:0.29, 0.61) as a predictor of 7 days ICU mortality. Daywise trend of ventilator parameters showed dynamic compliance was higher on day3 and 4 in survivors.ConclusionIn this cohort of ICU patients, ICU mortality was 60%. The reason for higher mortality could be the severity of illness as suggested by the day 1 PF ratio (109.31 [77.79-187.26]).Trial Registration-(IEC131/2020, CTRI/2020/06/025858).