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?:abstract
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RATIONALE: No direct comparisons of clinical features, laboratory values, and outcomes between critically ill patients with COVID-19 and influenza in the United States have been reported OBJECTIVE: To evaluate the risk of mortality comparing critically ill patients with COVID-19 to seasonal influenza METHODS: We retrospectively identified patients admitted to the intensive care units (ICUs) at two academic medical centers with laboratory confirmed SARS-CoV-2 or influenza A or B infections between January 1, 2019 and April 15, 2020 Clinical data were obtained by medical record review All patients except one had follow-up to hospital discharge or death We used relative risk regression adjusting for age, sex, number of comorbidities, and maximum sequential organ failure scores (SOFA) on ICU day 1 to determine the risk of hospital mortality and organ dysfunction in patients with COVID-19 compared to influenza RESULTS: We identified 65 critically ill patients with COVID-19 and 74 with influenza The mean (± standard deviation) age in each group was 60 4 +/- 15 7 and 56 8 +/- 17 6 years, respectively Patients with COVID-19 were more likely to be male, have higher body mass index and higher rates of chronic kidney disease and diabetes Thirty-seven percent of COVID-19 patients identified as Hispanic, compared to 10% of influenza patients A similar proportion of patients had fever (~40%) and lymphopenia (~80%) on hospital presentation Rates of acute kidney injury and shock requiring vasopressors were similar between the groups While need for invasive mechanical ventilation was also similar in both groups, patients with COVID-19 had slower improvements in oxygenation, longer durations of mechanical ventilation, and lower rates of extubation compared to patients with influenza Hospital mortality was 40% in COVID-19 patients and 19% in influenza patients (adjusted relative risk 2 13, 95% confidence interval 1 24 to 3 63;p = 0 006) CONCLUSIONS: Need for invasive mechanical ventilation was common in ICU patients with COVID-19 or influenza Compared to those with influenza, ICU patients with COVID-19 had worse respiratory outcomes, including longer duration of mechanical ventilation Additionally, patients with COVID-19 were at greater risk for in-hospital mortality, independent of age, sex, co-morbidities, and ICU severity of illness
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