P210 Not all Covid-19 deaths are hypoxic: observational cohort study of patients who died at the nightingale hospital Exeter

Adams, Kristen; Fearnley, C; Mankiewitz, R.; Hubbard, James; Reed, William W.; Whitehead, T. P.; Anning, Louise

doi:10.1136/thorax-2021-btsabstracts.319

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“…What was probably the most surprisingly and unexpected finding in this study was the poor outcomes for the hypoxaemia − /pneumonia − group with an overall mortality of 18.1%. Similarly, Adams et al reported a 32% mortality in COVID-19 patients without hypoxia 22. Among these patients, 14% still required ICU admission, and had a longer window of decompensation with ward to ICU transfer of 7.5 days.…”

Section: Discussionmentioning

confidence: 90%

“…Similarly, Adams et al reported a 32% mortality in COVID-19 patients without hypoxia. 22 Among these patients, 14% still required ICU admission, and had a longer window of decompensation with ward to ICU transfer of 7.5 days. It appears that the initial stability of these patients is not reassuring and is a patient subgroup that requires careful monitoring.…”

Section: Discussionmentioning

confidence: 99%

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Hospitalised COVID-19 outcomes are predicted by hypoxaemia and pneumonia phenotype irrespective of the timing of their emergence

et al. 2022

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Despite the known clinical importance of hypoxemia and pneumonia, there is a paucity of evidence for these variables with respect to risk of mortality and short-term outcomes among those hospitalised with COVID-19.ObjectiveDescribe the prevalence and clinical course of patients hospitalised with COVID-19 based on oxygenation and pneumonia status at presentation and determine the incidence of emergent hypoxaemia or radiographic pneumonia during admission.MethodsA retrospective study was conducted using a Canadian regional registry. Patients were stratified according to hypoxaemia/pneumonia phenotype and prevalence. Clinical parameters were compared between phenotypes using χ2and one-way Analysis of variance (ANOVA). Cox analysis estimated adjusted Hazard Ratios (HR) for associations between disease outcomes and phenotypes.ResultsAt emergency department (ED) admission, the prevalence of pneumonia and hypoxaemia was 43% and 50%, respectively, and when stratified to phenotypes: 28.2% hypoxaemia+/pneumonia+, 22.2% hypoxaemia+/pneumonia−, 14.5% hypoxaemia−/pneumonia+and 35.1% hypoxaemia−/pneumonia−. Mortality was 31.1% in the hypoxaemia+/pneumonia−group and 26.3% in the hypoxaemia+/pneumonia+group. Hypoxaemia with pneumonia and without pneumonia predicted higher probability of death. Hypoxaemia either <24 hours or ≥24 hours after hospitalisation predicted higher mortality and need for home oxygen compared with those without hypoxaemia. Patients with early hypoxaemia had higher probability of Intensive care unit (ICU) admission compared with those with late hypoxaemia.ConclusionMortality in COVID-19 infection is predicted by hypoxaemia with or without pneumonia and was greatest in patients who initially presented with hypoxaemia. The emergence of hypoxaemia was predicted by radiographic pneumonia. Patients with early and emergent hypoxaemia had similar mortality but were less likely to be admitted to ICU. There may be delayed identification of hypoxaemia, which prevents timely escalation of care.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%