Predictive Factors of Intubation in COVID-19 Patients: A Better Answer to the Ventilator Shortage Crisis?

Background: A pandemic of Coronavirus Disease 2019 (COVID-19) began in December 2019 in China leading to a global health crisis. Amid growing fears that the United States and the world could face a shortage of ventilators, less is known about early predictors of intubation and admissions to intensive care unit. Identifying these predictors will help facilitate proper allocation of patients and help physicians with better management during ventilator shortage crisis. The aim of our study to identify predictors of intubation in hospitalized COVID-19 patients. Methods: In this retrospective study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from two large university hospitals. Demographic, clinical and laboratory data were collected. Comparison was made between intubated and non-intubated patients. Univariate and multivariate regression methods were performed to identify predictive factors of intubation. Results: 159 patients were included, of whom 94 patients (59.1%) developed adult respiratory distress syndrome and 71 patients (44.6%) required intubation. Seventy-one patients (44.9%) were discharged, and 8 (5.1%) died. The most common comorbidities were diabetes mellitus 46.5% and bronchial asthma 14.5%. In our univariate analysis, age > 65, serum ferritin, C-reactive protein (CRP), lactate dehydrogenase (LDH) and neutrophil to lymphocyte ratio (NLR) were significantly higher in the intubated group. Procalcitonin and D-dimer levels were not predictive of intubation. Multivariate regression showed that elevated NRL and CRP were significant risk factors for intubation. Conclusions: The is the first and largest study from the United States to examine in depth predictors of intubation in COVID-19 patients. Laboratory studies at-admission including ferritin, LDH, NRL and CRP are independent prognostic factors for intubation and ICU admission. The risk of intubation was significantly higher with elevated NLR and CRP in our multivariate model. Future multi-institutional studies are warranted for validation of the role of these markers in relation to outcomes. Funding Statement: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Declaration of Interests: The authors have no conflicts of interest to declare. All co-authors have seen and agree with the contents of the manuscript and there is no financial interest to report. We certify that the submission is original work and is not under review at any other publication. Ethics Approval Statement: This is a retrospective study that was performed after institutional IRB approval.