Potential Predictors for Early Invasive Ventilation in Critically Ill Patients with COVID-19 in Wuhan, China: A Single-Centered, Retrospective, Observational Study

Background: In December 2019, an ongoing outbreak of coronavirus disease 2019 (COVID-19) occurred in Wuhan, China. While COVID-19 has become a global pandemic, the clinical data of critically ill patients are limited. We aimed to describe specific characteristics of critically ill patients with COVID-19 and identify potential early-warning predictors of invasive ventilation. Methods: In this single-centered, retrospective, observational study, we included adult inpatients (≥18 years old) with confirmed COVID-19 who received invasive ventilation from Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (Wuhan, China) between January 10 and February 29, 2020. Demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Univariable and multivariable linear regression analyses were used to assess the association between clinical parameters on hospital admission and duration from admission to invasive ventilation. Findings: 75 critically ill patients with confirmed COVID-19 who received invasive ventilation were included in this study. The median durations from symptoms onset to invasive ventilation, and from hospital admission to invasive ventilation were 18.0 days (IQR, 14·0–24·0) and 6·0 days (IQR, 4·0–10·0), respectively. Before invasive ventilation, levels of total protein and albumin decreased (p<0·0001), while white blood cell counts (p<0·0001), neutrophil counts (p<0·0001), levels of lactate dehydrogenase (LDH) (p=0·0041), high-sensitivity cardiac troponin I (p=0·045), and N-terminal pro-B-type natriuretic peptide (p=0·001) increased in critically ill patients with COVID-19. Univariable and multivariable regression analyses showed that age (β=0·37; regression coefficient: 0·22; 95% confidence interval [CI], 0·10–0·33; p<0·0001), LDH (-0·25; -0·01, -0·01– -0·00; p=0·014), blood glucose (-0·25; -0·27, -0·49– -0·05; p=0·016), and monocyte-to-lymphocyte ratio (MLR) (-0·19; -1·28, -2·56– -0·01; p=0·049) were independently associated with duration from hospital admission to invasive ventilation. Interpretation: Younger age, higher levels of LDH, blood glucose, and MLR on hospital admission are associated with shorter duration from admission to invasive ventilation. These potential predictors facilitate the identification of rapid disease progression and earlier requirement for invasive ventilation in patients with COVID-19. Funding Statement: None. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by the Institutional Ethics Board of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (TJ-IRB20200347). Written informed consent was waived by the Institutional Ethics Board.