{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T16:19:20Z","timestamp":1786378760306,"version":"build-2736575974"},"reference-count":207,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T00:00:00Z","timestamp":1724112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Our study aimed to describe the group of severe COVID-19 patients at an institutional level, and determine factors associated with different outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective chart review of patients admitted with severe acute hypoxic respiratory failure due to COVID-19 infection. Based on outcomes, we categorized 3 groups of severe COVID-19: (1) Favorable outcome: progressive care unit admission and discharge (2) Intermediate outcome: ICU care (3) Poor outcome: in-hospital mortality.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Eighty-nine patients met our inclusion criteria; 42.7% were female. The average age was 59.7 (standard deviation (SD):13.7). Most of the population were Caucasian (95.5%) and non-Hispanic (91.0%). Age, sex, race, and ethnicity were similar between outcome groups. Medicare and Medicaid patients accounted for 62.9%. The average BMI was 33.5 (SD:8.2). Moderate comorbidity was observed, with an average Charlson Comorbidity index (CCI) of 3.8 (SD:2.6). There were no differences in the average CCI between groups(p = 0.291). Many patients (67.4%) had hypertension, diabetes (42.7%) and chronic lung disease (32.6%). A statistical difference was found when chronic lung disease was evaluated; p = 0.002. The prevalence of chronic lung disease was 19.6%, 27.8%, and 40% in the favorable, intermediate, and poor outcome groups, respectively. Smoking history was associated with poor outcomes (p = 0.04). Only 7.9% were fully vaccinated. Almost half (46.1%) were intubated and mechanically ventilated. Patients spent an average of 12.1 days ventilated (SD:8.5), with an average of 6.0 days from admission to ventilation (SD:5.1). The intermediate group had a shorter average interval from admission to ventilator (77.2 hours, SD:67.6), than the poor group (212.8 hours, SD:126.8); (p = 0.001). The presence of bacterial pneumonia was greatest in the intermediate group (72.2%), compared to the favorable group (17.4%), and the poor group (56%); this was significant (p&lt;0.0001). In-hospital mortality was seen in 28.1%.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Most patients were male, obese, had moderate-level comorbidity, a history of tobacco abuse, and government-funded insurance. Nearly 50% required mechanical ventilation, and about 28% died during hospitalization. Bacterial pneumonia was most prevalent in intubated groups. Patients who were intubated with a good outcome were intubated earlier during their hospital course, with an average difference of 135.6 hours. A history of cigarette smoking and chronic lung disease were associated with poor outcomes.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0304960","type":"journal-article","created":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T18:08:38Z","timestamp":1724177318000},"page":"e0304960","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Severe COVID-19 infection: An institutional review and literature overview"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1730-1411","authenticated-orcid":true,"given":"Ogheneyoma","family":"Akpoviroro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan Kyle","family":"Sauers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Queeneth","family":"Uwandu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myriam","family":"Castagne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oghenetejiro Princess","family":"Akpoviroro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Humayun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wasique","family":"Mirza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jameson","family":"Woodard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,20]]},"reference":[{"issue":"1","key":"pone.0304960.ref001","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12985-022-01786-2","article-title":"Characteristics of lymphocyte subsets and cytokine profiles of patients with COVID-19.","volume":"19","author":"P Pan","year":"2022","journal-title":"Virol J."},{"issue":"11","key":"pone.0304960.ref002","first-page":"1061","article-title":"Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China [published correction appears in JAMA. 2021 Mar 16;325(11):1113].","volume":"323","author":"D Wang","year":"2020","journal-title":"JAMA"},{"issue":"12","key":"pone.0304960.ref003","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1016\/j.jiph.2020.07.014","article-title":"COVID-19 and comorbidities: Deleterious impact on infected patients.","volume":"13","author":"H Ejaz","year":"2020","journal-title":"J Infect Public Health"},{"key":"pone.0304960.ref004","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.ajem.2020.12.076","article-title":"Inflammatory and hematologic markers as predictors of severe outcomes in COVID-19 infection: A systematic review and meta-analysis.","volume":"41","author":"TI Hariyanto","year":"2021","journal-title":"Am J Emerg Med"},{"issue":"5","key":"pone.0304960.ref005","doi-asserted-by":"crossref","first-page":"2000547","DOI":"10.1183\/13993003.00547-2020","article-title":"Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis","volume":"55","author":"WJ Guan","year":"2020","journal-title":"Eur Respir J"},{"issue":"10223","key":"pone.0304960.ref006","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0140-6736(20)30211-7","article-title":"Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study","volume":"395","author":"N Chen","year":"2020","journal-title":"Lancet"},{"issue":"20","key":"pone.0304960.ref007","first-page":"2052","article-title":"Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area [published correction appears in JAMA. 2020 May 26;323(20):2098].","volume":"323","author":"S Richardson","year":"2020","journal-title":"JAMA"},{"issue":"1","key":"pone.0304960.ref008","doi-asserted-by":"crossref","first-page":"e84","DOI":"10.1016\/j.jinf.2020.03.059","article-title":"Arterial hypertension and risk of death in patients with COVID-19 infection: Systematic review and meta-analysis.","volume":"81","author":"M Zuin","year":"2020","journal-title":"J Infect."},{"issue":"8","key":"pone.0304960.ref009","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1007\/s00125-020-05180-x","article-title":"Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study","volume":"63","author":"B. 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