Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study
|Collaboration||Suh, Noémie / Primmaz, Steve / Pugin, Jérôme|
|Published in||Intensive care medicine. 2021, vol. 47, no. 1, p. 60-73|
Purpose: To describe acute respiratory distress syndrome (ARDS) severity, ventilation management, and the outcomes of ICU patients with laboratory-confirmed COVID-19 and to determine risk factors of 90-day mortality post-ICU admission.
Methods: COVID-ICU is a multi-center, prospective cohort study conducted in 138 hospitals in France, Belgium, and Switzerland. Demographic, clinical, respiratory support, adjunctive interventions, ICU length-of-stay, and survival data were collected.
Results: From February 25 to May 4, 2020, 4643 patients (median [IQR] age 63 [54-71] years and SAPS II 37 [28-50]) were admitted in ICU, with day-90 post-ICU admission status available for 4244. On ICU admission, standard oxygen therapy, high-flow oxygen, and non-invasive ventilation were applied to 29%, 19%, and 6% patients, respectively. 2635 (63%) patients were intubated during the first 24 h whereas overall 3376 (80%) received invasive mechanical ventilation (MV) at one point during their ICU stay. Median (IQR) positive end-expiratory and plateau pressures were 12 (10-14) cmH2O, and 24 (21-27) cmH2O, respectively. The mechanical power transmitted by the MV to the lung was 26.5 (18.6-34.9) J/min. Paralyzing agents and prone position were applied to 88% and 70% of patients intubated at Day-1, respectively. Pulmonary embolism and ventilator-associated pneumonia were diagnosed in 207 (9%) and 1209 (58%) of these patients. On day 90, 1298/4244 (31%) patients had died. Among patients who received invasive or non-invasive ventilation on the day of ICU admission, day-90 mortality increased with the severity of ARDS at ICU admission (30%, 34%, and 50% for mild, moderate, and severe ARDS, respectively) and decreased from 42 to 25% over the study period. Early independent predictors of 90-day mortality were older age, immunosuppression, severe obesity, diabetes, higher renal and cardiovascular SOFA score components, lower PaO2/FiO2 ratio and a shorter time between first symptoms and ICU admission.
Conclusion: Among more than 4000 critically ill patients with COVID-19 admitted to our ICUs, 90-day mortality was 31% and decreased from 42 to 25% over the study period. Mortality was higher in older, diabetic, obese and severe ARDS patients.
|Keywords||Acute respiratory distress syndrome — COVID-19 — Mechanical ventilation — Mortality risk factor — Outcome — Aged — Belgium / epidemiology — COVID-19 / complications — COVID-19 / mortality — Critical Illness — Female — France / epidemiology — Hospital Mortality — Humans — Intensive Care Units — Kaplan-Meier Estimate — Male — Middle Aged — Patient Acuity — Prospective Studies — Respiration, Artificial — Respiratory Distress Syndrome / etiology — Respiratory Distress Syndrome / mortality — Respiratory Distress Syndrome / therapy — Risk Factors — SARS-CoV-2|
Article (Published version) (1.1 MB) - Free access
Appendix (597 Kb) - Free access
Other version: https://link.springer.com/article/10.1007/s00134-020-06294-x
|Research group||Groupe Pugin Jérôme (Soins intensifs) (587)|
|COVID-ICU GROUP ON BEHALF OF THE REVA NETWORK AND THE COVID-ICU INVESTIGATORS. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. In: Intensive care medicine, 2021, vol. 47, n° 1, p. 60-73. doi: 10.1007/s00134-020-06294-x https://archive-ouverte.unige.ch/unige:161818|