AUTHOR=Suarez-Cuartin Guillermo , Gasa Merce , Bermudo Guadalupe , Ruiz Yolanda , Hernandez-Argudo Marta , Marin Alfredo , Trias-Sabria Pere , Cordoba Ana , Cuevas Ester , Sarasate Mikel , Ariza Albert , Sabater Joan , Romero Nuria , Subirana Cristina , Molina-Molina Maria , Santos Salud 

TITLE=Clinical Outcomes of Severe COVID-19 Patients Admitted to an Intermediate Respiratory Care Unit

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.711027

DOI=10.3389/fmed.2021.711027

ISSN=2296-858X

ABSTRACT=<p><bold>Introduction:</bold> Many severe COVID-19 patients require respiratory support and monitoring. An intermediate respiratory care unit (IMCU) may be a valuable element for optimizing patient care and limited health-care resources management. We aim to assess the clinical outcomes of severe COVID-19 patients admitted to an IMCU.</p><p><bold>Methods:</bold> Observational, retrospective study including patients admitted to the IMCU due to COVID-19 pneumonia during the months of March and April 2020. Patients were stratified based on their requirement of transfer to the intensive care unit (ICU) and on survival status at the end of follow-up. A multivariable Cox proportional hazards method was used to assess risk factors associated with mortality.</p><p><bold>Results:</bold> A total of 253 patients were included. Of them, 68% were male and median age was 65 years (IQR 18 years). Ninety-two patients (36.4%) required ICU transfer. Patients transferred to the ICU had a higher mortality rate (44.6 vs. 24.2%; <italic>p</italic> &lt; 0.001). Multivariable proportional hazards model showed that age ≥65 years (HR 4.14; 95%CI 2.31–7.42; <italic>p</italic> &lt; 0.001); chronic respiratory conditions (HR 2.34; 95%CI 1.38–3.99; <italic>p</italic> = 0.002) and chronic kidney disease (HR 2.96; 95%CI 1.61–5.43; <italic>p</italic> &lt; 0.001) were independently associated with mortality. High-dose systemic corticosteroids followed by progressive dose tapering showed a lower risk of death (HR 0.15; 95%CI 0.06–0.40; <italic>p</italic> &lt; 0.001).</p><p><bold>Conclusions:</bold> IMCU may be a useful tool for the multidisciplinary management of severe COVID-19 patients requiring respiratory support and non-invasive monitoring, therefore reducing ICU burden. Older age and chronic respiratory or renal conditions are associated with worse clinical outcomes, while treatment with systemic corticosteroids may have a protective effect on mortality.</p>