Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: A prospective, cohort, multicentre study

Abstract

Background The clinical course of COVID-19 critically ill patients, during their admission in the intensive care unit (UCI), including medical and infectious complications and support therapies, as well as their association with in-ICU mortality has not been fully reported. Objective This study aimed to describe clinical characteristics and clinical course of ICU COVID-19 patients, and to determine risk factors for ICU mortality of COVID-19 patients. Methods Prospective, multicentre, cohort study that enrolled critically ill COVID-19 patients admitted into 30 ICUs from Spain and Andorra. Consecutive patients from March 12th to May 26th, 2020 were enrolled if they had died or were discharged from ICU during the study period. Demographics, symptoms, vital signs, laboratory markers, supportive therapies, pharmacological treatments, medical and infectious complications were reported and compared between deceased and discharged patients. Results A total of 663 patients were included. Overall ICU mortality was 31% (203 patients). At ICU admission non-survivors were more hypoxemic [SpO 2 with non-rebreather mask, 90 (IQR 83–93) vs 91 (IQR 87–94); p < 0.001] and with higher sequential organ failure assessment score [SOFA, 7 (IQR 5–9) vs 4 (IQR 3–7); p < 0.001]. Complications were more frequent in non-survivors: acute respiratory distress syndrome (ARDS) (95% vs 89%; p = 0.009), acute kidney injury (AKI) (58% vs 24%; p < 10 −16 ), shock (42% vs 14%; p < 10 −13 ), and arrhythmias (24% vs 11%; p < 10 −4 ). Respiratory super-infection, bloodstream infection and septic shock were higher in non-survivors (33% vs 25%; p = 0.03, 33% vs 23%; p = 0.01 and 15% vs 3%, p = 10 −7 ), respectively. The multivariable regression model showed that age was associated with mortality, with every year increasing risk-of-death by 1% (95%CI: 1–10, p = 0.014). Each 5-point increase in APACHE II independently predicted mortality [OR: 1.508 (1.081, 2.104), p = 0.015]. Patients with AKI [OR: 2.468 (1.628, 3.741), p < 10 −4 )], cardiac arrest [OR: 11.099 (3.389, 36.353), p = 0.0001], and septic shock [OR: 3.224 (1.486, 6.994), p = 0.002] had an increased risk-of-death. Conclusions Older COVID-19 patients with higher APACHE II scores on admission, those who developed AKI grades II or III and/or septic shock during ICU stay had an increased risk-of-death. ICU mortality was 31%.

Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study

“…A high number of patients with coronavirus disease 19 (COVID-19) develop severe bilateral viral pneumonia. Many COVID-19 patients evolve to acute respiratory distress syndrome (ARDS), characterized by profound hypoxemia and an associated high mortality rate [1,2]. High-flow nasal oxygen therapy (HFNO) is effective in decreasing the need for endotracheal intubation in patients with acute hypoxemic respiratory failure (ARF) [3].…”

Awake Prone Positioning Does Not Reduce the Risk of Intubation in COVID-19 Treated with High-Flow Nasal Oxygen Therapy. A Multicenter, Adjusted Cohort Study

“…Many COVID-19 patients evolve to acute respiratory distress syndrome (ARDS), characterized by profound hypoxemia and an associated high mortality rate. 1,2 High-ow nasal oxygen therapy (HFNO) is effective in decreasing the need for endotracheal intubation in patients with acute hypoxemic respiratory failure (ARF). 3 However, the lack of proven bene ts in COVID-19 patients together with the concerns of increased risk of aerosolization, led to recommending early intubation and invasive mechanical ventilation (MV) at the beginning of the pandemic.…”

Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome

“… 24 APACHE II is one of the important predictive factors of mortality in ICU and high scores are associated with nonsurvivors. 25 The present study population had a median APACHE II score of 11.…”