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<p>Clinical outcomes of critically ill COVID-19 patients admitted to intensive care units (ICUs) remain heterogeneous, and factors influencing mortality require further characterization. This retrospective study evaluated clinical outcomes among 1,344 adult patients with confirmed COVID-19 admitted to ICUs across four governmental hospitals in Kuwait between June 2020 and December 2022. Survival outcomes were assessed using Kaplan–Meier survival analysis and compared by demographic and clinical characteristics. Cox proportional hazards regression was applied to identify factors associated with mortality, while comorbidities and treatment patterns were evaluated in relation to patient outcomes. Survival probability declined from 98% at 5 days to 50% at one year. Kaplan–Meier analysis showed significant differences in survival according to age and diabetes status. Non-survivors were older (66 vs. 55 years, <i>p</i> &lt; 0.001), had a higher prevalence of diabetes (60.9%) and hypertension (70.4%), and experienced longer hospital stays. Hypoxia was strongly associated with mortality (<i>p</i> &lt; 0.001). In Cox regression analysis, adjusted for pandemic admission wave to account for evolving ICU management, increasing age (HR = 1.04 per year, 95% CI 1.03–1.04), fever (HR = 1.18, 95% CI 1.01–1.39), and chronic kidney disease (HR = 1.40, 95% CI 1.11–1.76) were associated with higher mortality. In contrast, anti-inflammatory drug use was associated with reduced risk (HR = 0.52, 95% CI 0.43–0.63) as was anticoagulant (HR = 0.80, 95% CI 0.66–0.97). Antifungal use was associated with increased mortality risk (HR = 1.68, 95% CI: 1.30–2.16); however, associations involving medications likely reflect underlying disease severity and treatment indication rather than direct causal effects. Sensitivity analysis using a split follow-up at day 30 demonstrated that antifungal-associated risk was concentrated during the late follow-up period (HR = 2.10, days 31–365), consistent with late-onset secondary fungal infections among patients with prolonged critical illness.</p>

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The clinical outcomes of critically Ill COVID-19 patients in intensive care units of Kuwait governmental hospitals: a retrospective analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月8日

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  • Mashael Al-Mutairi,
  • Ahmad Alenezi,
  • Awatef Almutairi,
  • Hani Almutairi,
  • Zafer AlAjmi,
  • Manar Almutairi,
  • Suad Alfadhli,
  • Meshal Daalah,
  • Hany Habashy,
  • Ahlam Jeragh

摘要

Clinical outcomes of critically ill COVID-19 patients admitted to intensive care units (ICUs) remain heterogeneous, and factors influencing mortality require further characterization. This retrospective study evaluated clinical outcomes among 1,344 adult patients with confirmed COVID-19 admitted to ICUs across four governmental hospitals in Kuwait between June 2020 and December 2022. Survival outcomes were assessed using Kaplan–Meier survival analysis and compared by demographic and clinical characteristics. Cox proportional hazards regression was applied to identify factors associated with mortality, while comorbidities and treatment patterns were evaluated in relation to patient outcomes. Survival probability declined from 98% at 5 days to 50% at one year. Kaplan–Meier analysis showed significant differences in survival according to age and diabetes status. Non-survivors were older (66 vs. 55 years, p < 0.001), had a higher prevalence of diabetes (60.9%) and hypertension (70.4%), and experienced longer hospital stays. Hypoxia was strongly associated with mortality (p < 0.001). In Cox regression analysis, adjusted for pandemic admission wave to account for evolving ICU management, increasing age (HR = 1.04 per year, 95% CI 1.03–1.04), fever (HR = 1.18, 95% CI 1.01–1.39), and chronic kidney disease (HR = 1.40, 95% CI 1.11–1.76) were associated with higher mortality. In contrast, anti-inflammatory drug use was associated with reduced risk (HR = 0.52, 95% CI 0.43–0.63) as was anticoagulant (HR = 0.80, 95% CI 0.66–0.97). Antifungal use was associated with increased mortality risk (HR = 1.68, 95% CI: 1.30–2.16); however, associations involving medications likely reflect underlying disease severity and treatment indication rather than direct causal effects. Sensitivity analysis using a split follow-up at day 30 demonstrated that antifungal-associated risk was concentrated during the late follow-up period (HR = 2.10, days 31–365), consistent with late-onset secondary fungal infections among patients with prolonged critical illness.