{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T09:33:43Z","timestamp":1761989623592,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T00:00:00Z","timestamp":1629936000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Backgroundand Objectives: COVID-19 is a novel infectious disease caused by a single-stranded RNA coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to conduct a nationwide multicenter study to determine the characteristics and the clinical prognostic outcome of critically ill COVID-19 patients admitted to intensive care units (ICUs). Materials and Methods: This is a nationwide cohort retrospective study conducted in twenty Saudi hospitals. Results: An analysis of 1470 critically ill COVID-19 patients demonstrated that the majority of patients were male with a mean age of 55.9 \u00b1 15.1 years. Most of our patients presented with a shortness of breath (SOB) (81.3%), followed by a fever (73.7%) and a cough (65.1%). Diabetes and hypertension were the most common comorbidities in the study (52.4% and 46.0%, respectively). Multiple complications were observed substantially more among non-survivors. The length and frequency of mechanical ventilation use were significantly greater (83%) in the non-survivors compared with the survivors (31%). The mean Sequential Organ Failure Assessment (SOFA) score was 6 \u00b1 5. The overall mortality rate of the cohort associated with patients that had diabetes, hypertension and ischemic heart disease was 41.8%. Conclusion: Age; a pre-existing medical history of hypertension, diabetes and ischemic heart disease; smoking cigarettes; a BMI \u2265 29; a long mechanical ventilation and ICU stay; the need of ventilatory support; a high SOFA score; fungal co-infections and extracorporeal membrane oxygenation (ECMO) use were key clinical characteristics that predicted a high mortality in our population.<\/jats:p>","DOI":"10.3390\/medicina57090878","type":"journal-article","created":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T09:27:57Z","timestamp":1629970077000},"page":"878","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Examining the Clinical Prognosis of Critically Ill Patients with COVID-19 Admitted to Intensive Care Units: A Nationwide Saudi Study"],"prefix":"10.3390","volume":"57","author":[{"given":"Abbas","family":"Al Mutair","sequence":"first","affiliation":[{"name":"Research Center, Almoosa Specialist Hospital, Al-Ahsa 31982, Saudi Arabia"},{"name":"College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh 12214, Saudi Arabia"},{"name":"School of Nursing, University of Wollongong, Wollongong, NSW 2522, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyaa","family":"Elhazmi","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Almoosa Specialist Hospital, Al-Ahsa 31982, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4552-4513","authenticated-orcid":false,"given":"Saad","family":"Alhumaid","sequence":"additional","affiliation":[{"name":"Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2497-7532","authenticated-orcid":false,"given":"Gasmelseed","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Research Center, Almoosa Specialist Hospital, Al-Ahsa 31982, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6774-9847","authenticated-orcid":false,"given":"Ali","family":"Rabaan","sequence":"additional","affiliation":[{"name":"Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31982, Saudi Arabia"},{"name":"Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Alghadeer","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Alomran General Hospital, Al-Ahsa 36358, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3483-5941","authenticated-orcid":false,"given":"Hiba","family":"Chagla","sequence":"additional","affiliation":[{"name":"School of Medicine, RCSI Bahrain, Busaiteen 15503, Bahrain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raghavendra","family":"Tirupathi","sequence":"additional","affiliation":[{"name":"Department of Medicine Keystone Health, Penn University School of Medicine, Hershey, PA 16801, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit","family":"Sharma","sequence":"additional","affiliation":[{"name":"Geisinger Community Medical Center, Geisinger Health System, Scranton, PA 18510, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7469-4752","authenticated-orcid":false,"given":"Kuldeep","family":"Dhama","sequence":"additional","affiliation":[{"name":"Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatangar, Bareilly 243122, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khulud","family":"Alsalman","sequence":"additional","affiliation":[{"name":"AlJaber Hospital for Eye & ENT, Ministry of Health, Al-Ahsa 31973, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zainab","family":"Alalawi","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, College of Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziyad","family":"Aljofan","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud University, Riyadh 54321, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4181-6279","authenticated-orcid":false,"given":"Alya","family":"Al Mutairi","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Faculty of Science, Taibah University, Medina 54321, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Alomari","sequence":"additional","affiliation":[{"name":"Palliative Care Department, King Fahad Medical City, Riyadh 12214, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mansour","family":"Awad","sequence":"additional","affiliation":[{"name":"Commitment Administration, General Directorate of Health Affairs, Ministry of Health, Medina 42351, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Awad","family":"Al-Omari","sequence":"additional","affiliation":[{"name":"Research Center, Dr. Sulaiman Al Habib Medical Group, Alfaisal University, Riyadh 12214, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s40001-020-00462-x","article-title":"Clinical, epidemiological, and laboratory characteristics of mild-to-moderate COVID-19 patients in Saudi Arabia: An observational cohort study","volume":"25","author":"Alhumaid","year":"2020","journal-title":"Eur. J. Med. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of coronavirus disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"102026","DOI":"10.1016\/j.tmaid.2021.102026","article-title":"Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) coinfection: A unique case series","volume":"41","author":"Elhazmi","year":"2021","journal-title":"Travel. Med. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Thomson, R.J., Hunter, J., Dutton, J., Schneider, J., Khosravi, M., Casement, A., Dhadwal, K., and Martin, D. (2020). Clinical characteristics and outcomes of critically ill patients with COVID-19 admitted to an intensive care unit in London: A prospective observational cohort study. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0243710"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3719","DOI":"10.2147\/IJGM.S313757","article-title":"Clinical Predictors of COVID-19 Mortality Among Patients in Intensive Care Units: A Retrospective Study","volume":"14","author":"Zaidi","year":"2021","journal-title":"Int. J. Gen. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Alhumaid, S., Mutair, A.A., Alawi, Z.A., Alhmeed, N., Zaidi, A.R.Z., and Tobaiqy, M. (2020). Efficacy and safety of lopinavir\/ritonavir for treatment of COVID-19: A systematic review and meta-analysis. Trop. Med. Infect. Dis., 5.","DOI":"10.3390\/tropicalmed5040180"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/S1473-3099(20)30120-1","article-title":"An interactive web-based dashboard to track COVID-19 in real time","volume":"20","author":"Dong","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1056\/NEJMc2005073","article-title":"SARS-CoV-2 infection in children","volume":"382","author":"Lu","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Rabaan, A.A., Al-Ahmed, S.H., Garout, M.A., Al-Qaaneh, A.M., Sule, A.A., Tirupathi, R., Mutair, A., Alhumaid, S., Hasan, A., and Dhawan, M. (2021). Diverse Immunological Factors Influencing Pathogenesis in Patients with COVID-19: A Review on Viral Dissemination, Immunotherapeutic Options to Counter Cytokine Storm and Inflammatory Responses. Pathogens, 10.","DOI":"10.3390\/pathogens10050565"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Alshukry, A., Ali, H., Ali, Y., Al-Taweel, T., Abu-Farha, M., AbuBaker, J., Devarajan, S., Dashti, A.A., Bandar, A., and Taleb, H. (2020). Clinical characteristics of Coronavirus Disease 2019 (COVID-19) patients in Kuwait. PLoS ONE, 15.","DOI":"10.1101\/2020.06.14.20131045"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Bolcato, M., Aurilio, M.T., Aprile, A., Di Mizio, G., Della Pietra, B., and Feola, A. (2021). Take-home messages from the COVID-19 pandemic: Strengths and pitfalls of the italian national health service from a medico-legal point of view. Healthcare, 9.","DOI":"10.3390\/healthcare9010017"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Al Mutair, A., Al Mutairi, A., Alhumaid, S., Abdullah, S.M., Zaidi, A.R.Z., Rabaan, A.A., and Al-Omari, A. (2021). Examining and Investigating the Impact of Demographic Characteristics and Chronic Disease on Mortality of COVID-19: Retrospective study. PLoS ONE, in press.","DOI":"10.21203\/rs.3.rs-274197\/v1"},{"key":"ref_14","first-page":"10","article-title":"Airborne transmission of SARS-CoV-2 is the dominant route of transmission: Droplets and aerosols","volume":"29","author":"Rabaan","year":"2021","journal-title":"Infez. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s40001-021-00517-7","article-title":"Clinical features and prognostic factors of intensive and non-intensive 1014 COVID-19 patients: An experience cohort from Alahsa, Saudi Arabia","volume":"26","author":"Alhumaid","year":"2021","journal-title":"Eur. J. Med Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s00038-020-01390-7","article-title":"Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: A systematic review and meta-analysis","volume":"65","author":"Jain","year":"2020","journal-title":"Int. J. Public Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e21801","DOI":"10.2196\/21801","article-title":"Clinical characteristics and prognostic factors for intensive care unit admission of patients with COVID-19: Retrospective study using machine learning and natural language processing","volume":"22","author":"Izquierdo","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1001\/jama.2020.5394","article-title":"Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy","volume":"323","author":"Grasselli","year":"2020","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1001\/jama.2020.12603","article-title":"Persistent symptoms in patients after acute COVID-19","volume":"324","author":"Bernabei","year":"2020","journal-title":"JAMA"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e2012270","DOI":"10.1001\/jamanetworkopen.2020.12270","article-title":"Clinical characteristics and morbidity associated with coronavirus disease 2019 in a series of patients in metropolitan Detroit","volume":"3","author":"Suleyman","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Mascolo, P., Feola, A., Sementa, C., Leone, S., Zangani, P., Della Pietra, B., and Campobasso, C.P. (2021). A descriptive study on causes of death in hospitalized patients in an acute general hospital of Southern Italy during the lockdown due to COVID-19 outbreak. Healthcare, 9.","DOI":"10.3390\/healthcare9020119"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.redar.2020.07.003","article-title":"Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: A prospective, cohort, multicentre study","volume":"67","author":"Ferrando","year":"2020","journal-title":"Rev. Esp. Anestesiol. Reanim."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2000895","DOI":"10.2807\/1560-7917.ES.2020.25.48.2000895","article-title":"Clinical characteristics and risk factors associated with severe COVID-19: Prospective analysis of 1045 hospitalised cases in North-Eastern France, March 2020","volume":"25","author":"Kaeuffer","year":"2020","journal-title":"Eurosurveillance"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1111\/aas.13694","article-title":"Characteristics and outcomes of patients with COVID-19 admitted to ICU in a tertiary hospital in Stockholm, Sweden","volume":"65","author":"Larsson","year":"2021","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"m1985","DOI":"10.1136\/bmj.m1985","article-title":"Features of 20 133 UK patients in hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: Prospective observational cohort study","volume":"369","author":"Docherty","year":"2020","journal-title":"BMJ"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Borobia, A.M., Carcas, A.J., Arnalich, F., Alvarez-Sala, R., Monserrat-Villatoro, J., Quintana, M., Figueira, J.C., Santos-Olmo, R.M.T., Garc\u00eda-Rodr\u00edguez, J., and Mart\u00edn-Vega, A. (2020). A cohort of patients with COVID-19 in a major teaching hospital in Europe. J. Clin. Med., 9.","DOI":"10.3390\/jcm9061733"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1164\/rccm.202003-0736LE","article-title":"Clinical course and outcomes of 344 intensive care patients with COVID-19","volume":"201","author":"Wang","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators (2021). Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: A prospective cohort study. Intensive Care Med., 47, 60\u201373.","DOI":"10.1007\/s00134-020-06294-x"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.aucc.2020.10.009","article-title":"Mechanical ventilation and mortality among 223 critically ill patients with coronavirus disease 2019: A multicentric study in Germany","volume":"34","author":"Roedl","year":"2021","journal-title":"Aust. Crit. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"100449","DOI":"10.1016\/j.eclinm.2020.100449","article-title":"Prognostic factors associated with mortality risk and disease progression in 639 critically ill patients with COVID-19 in Europe: Initial report of the international RISC-19-ICU prospective observational cohort","volume":"25","author":"Garcia","year":"2020","journal-title":"EClinicalMedicine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e799","DOI":"10.1097\/CCM.0000000000004457","article-title":"ICU and ventilator mortality among critically ill adults with coronavirus disease 2019","volume":"48","author":"Auld","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"242","DOI":"10.4266\/acc.2020.00619","article-title":"Clinical characteristics and outcomes of critically Ill patients with COVID-19 in Northeast Ohio: Low mortality and length of stay","volume":"35","author":"Fadel","year":"2020","journal-title":"Acute Crit. Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1111\/imj.14963","article-title":"Impact of COVID-19 on an Australian intensive care unit: Lessons learned from South Australia","volume":"50","author":"Nadkarni","year":"2020","journal-title":"Intern. Med. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"4263","DOI":"10.1038\/s41598-021-82862-5","article-title":"Causes of death and comorbidities in hospitalized patients with COVID-19","volume":"11","author":"Elezkurtaj","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.hrtlng.2021.04.005","article-title":"The incidence, clinical characteristics, and outcomes of pneumothorax in hospitalized COVID-19 patients: A systematic review","volume":"50","author":"Chong","year":"2021","journal-title":"Heart Lung"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/9\/878\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:52:36Z","timestamp":1760165556000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/9\/878"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,26]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["medicina57090878"],"URL":"https:\/\/doi.org\/10.3390\/medicina57090878","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2021,8,26]]}}}