Background
Information is lacking regarding long-term survival and predictive factors for mortality in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) and undergoing invasive mechanical ventilation. We aimed to estimate 180-day mortality of patients with COVID-19 requiring invasive ventilation, and to develop a predictive model for long-term mortality.
Methods
Retrospective, multicentre, national cohort study between March 8 and April 30, 2020 in 16 intensive care units (ICU) in Spain. Participants were consecutive adults who received invasive mechanical ventilation for COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected in positive testing of a nasopharyngeal sample and confirmed by real time reverse-transcriptase polymerase chain reaction (rt-PCR). The primary outcomes was 180-day survival after hospital admission. Secondary outcomes were length of ICU and hospital stay, and ICU and in-hospital mortality. A predictive model was developed to estimate the probability of 180-day mortality.
Results
868 patients were included (median age, 64 years [interquartile range [IQR], 56–71 years]; 72% male). Severity at ICU admission, estimated by SAPS3, was 56 points [IQR 50–63]. Prior to intubation, 26% received some type of noninvasive respiratory support. The unadjusted overall 180-day survival rates was 59% (95% CI 56–62%). The predictive factors measured during ICU stay, and associated with 180-day mortality were: age [Odds Ratio [OR] per 1-year increase 1.051, 95% CI 1.033–1.068)), SAPS3 (OR per 1-point increase 1.027, 95% CI 1.011–1.044), diabetes (OR 1.546, 95% CI 1.085–2.204), neutrophils to lymphocytes ratio (OR per 1-unit increase 1.008, 95% CI 1.001–1.016), failed attempt of noninvasive positive pressure ventilation prior to orotracheal intubation (OR 1.878 (95% CI 1.124–3.140), use of selective digestive decontamination strategy during ICU stay (OR 0.590 (95% CI 0.358–0.972) and administration of low dosage of corticosteroids (methylprednisolone 1 mg/kg) (OR 2.042 (95% CI 1.205–3.460).
Conclusion
The long-term survival of mechanically ventilated patients with severe COVID-19 reaches more than 50% and may help to provide individualized risk stratification and potential treatments.
Trial registration: ClinicalTrials.gov Identifier: NCT04379258. Registered 10 April 2020 (retrospectively registered)
Purpose
We examined the ability of the P(v‐a)CO2/Da‐vO2 ratio combined with elevated lactate levels to predict early allograft dysfunction (EAD).
Materials and methods
Patients were classified into four groups according to lactate levels and P(v‐a)CO2/Da‐vO2 ratio: Group 1; lactate >2.0 mmol/L and P(v‐a)CO2/Da‐vO2 ratio >1.0; Group 2; lactate >2.0 mmol/L and P(v‐a)CO2/Da‐vO2 ratio <1.0; group 3; lactate<2.0 mmol/L and P(v‐a)CO2/Da‐vO2 ratio >1.0; group 4; lactate<2.0 mmol/L and P(v‐a)CO2/Da‐vO2 ratio <1.0. We defined EAD according to Olthoff criteria.
Results
One‐hundred and fifty patients were included. EAD occurred in 41 patients (27.3%), and was associated with worse graft survival at 1 year (92% vs. 73%; P = ,003) as well as a higher re‐transplantation rate (4,6% vs. 17,1%; P = ,019). The multivariate analysis revealed that P(v‐a)CO2/Da‐vO2 ratio at T6 [OR 7.05(CI95% 2.77–19.01, P<.001)] was an independent predictor for EAD. Belonging to group 1 at 6 h was associated with worse clinical outcomes but no association was found with 1‐year graft survival or 1‐year patient survival.
Conclusions
In this single center, prospective, observational study in patients who received an OLT, we found that elevated lactate levels combined with a high Cv‐aCO2/Da‐vO2 after 6 h was associated with the development of EAD and worse clinical outcomes in the early postoperative period.
To the Editor: We appreciate the work of Jorge Ortega-Hernández (1) in which he proposes to assess the predictive capacity of clinical-prognostic models in patients with cardiogenic shock. The results of his work reveal two pieces of information that we believe deserve further reflection:
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