Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units

Abstract

Background: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. Aims: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. Study design: Retrospective, observational cohort. Methods: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. Results: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO 2 /FiO 2 ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050). Conclusion: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.

Association of vasopressors with mortality in critically ill patients with COVID-19: A systematic review and meta-analysis

“…The studies originated from multiple countries, with 13 of coming from institutions located in the USA [20,21,23,[32][33][34][35]38,42,43,45,48,51]. Nineteen studies included only patients admitted in the ICU [20,22,24,25,27,[30][31][32][35][36][37][38][39][43][44][45][46][47]52], five studies included patients admitted in a COVID-19-dedicated HDU [28,29,33,34,42], eight studies included patients who were admitted in both HDU and ICU [21,23,26,40,41,48,49,51], and one study included Emergency Department patients who were later admitted either in the HDU of ICU [50]. Thirty studies included data about patients who received vs. patients who did not receive vasopressors…”

“…Twenty-one out of the 33 included studies provided data on hospital mortality in patients who received vs. patients who did not receive vasopressors, resulting in a total population of 7900 individuals [25,27,[31][32][33][34][35][36][37][39][40][41][42][43][44][45][46][47][48]50,52]. Due to high heterogeneity (I 2 : 94%, PQ<0.001), the random-effects model was implemented.…”

Gastrointestinal Bleeding In COVID-19 Infection: A case-control study

“…These findings were similar to the results of the multicenter COVID-19-ICU study in our country. In this multicenter study, 58.6% of the male patients and 51.3% of them had hypertension, the most common comorbidity, and the other common comorbidities were diabetes mellitus and cardiac disease (12). Similarly, in Italy, the most common comorbidity was hypertension, and was more common in male patients.…”

Management of COVID-19-Associated Acute Respiratory Failure with Alternatives to Invasive Mechanical Ventilation: High-Flow Oxygen, Continuous Positive Airway Pressure, and Noninvasive Ventilation

“…In patients with COVID-19-associated ARF, the PaO 2 /FiO 2 ratio was able to predict severity in a cohort of 421 patients [ 26 ], as well as in a smaller cohort of 150 patients. In the latter cohort, the authors were able to calculate an optimal cut-off PaO 2 /FiO 2 ratio of 274 mmHg, which could distinguish between patients with mild disease and patients with severe disease with a sensitivity of 72% and specificity 85% [ 27 ], and it also contributed to a predictive composite score along with age, platelets, pH, blood urea nitrogen, temperature, PaCO 2 , and Glasgow Coma Scale in a cohort of 937 patients [ 28 ].…”