Predicting the Need for Invasive Mechanical Ventilation in Patients With Coronavirus Disease 2019

Abstract

To generate a preliminary version of a novel risk score to predict the need for invasive mechanical ventilation (MV) in patients with COVID-19. METHODS: Retrospective analysis of patients >18 years-of-age with laboratory-confirmed COVID-19 admitted between March 15-April 15, 2020 to a tertiary-care center. Demographic, laboratory, clinical, and outcome information were recorded, using a standard data-collection format. RESULTS: The cohort included 265 subjects (mean age 59.3 AE16.4 years, 55.1% male) and 54 (20.4%) required invasive MV. Significant between-group univariate results, based on the need for invasive MV, were used in multiple-regression analysis. Admission heart rate (HR) (OR 1.032 [CI 1.013-1.015]; p<0.001), SpO2/FIO2 (S/F) ratio (OR .619 [CI .463-.829]; p=0.001), and any positive initial troponin (TnI) (OR 4.18 [CI 1.93-9.036]; p<0.001] independently predicted the need for invasive MV. The best cutoff points for the variables HR and S/F ratio were also determined: HR >101.5 BPM (AUC 0.686, 68.5% sensitivity & 66.4% specificity) and S/F ratio <4.4 (AUC 0.714, 72.2% sensitivity & 61.6% specificity). The overall model showed good calibration (Hosmer-Lemeshow = 6.3; p=0.39) and predictive ability (AUC = .80). Patients with a single, positive variable had an invasive MV risk = 15.4%, but this increased to 29% with 2 variables and 60.5% (p<0.001) with the presence of all 3. CONCLUSIONS: This pilot study provides insight into early factors related to patient acuity and the use of medical resources. Thresholds for 3 common clinical variables-HR, S/F ratio and TnIpredicted the need for invasive MV with good accuracy and provide an easily-applied scoring system to determine risk. CLINICAL IMPLICATIONS: We developed a simple, novel risk score to quantify the need for invasive MV in COVID-19 patients, with preliminary testing showing the 3 components had good predictive ability.

Utility of Age-adjusted Charlson Comorbidity Index as a Predictor of Need for Invasive Mechanical Ventilation, Length of Hospital Stay, and Survival in COVID-19 Patients

“…A study that predicted the need for IMV concluded three factors at admission as significantheart rate >101.5, oxygen saturation-to-fraction of inspired oxygen ratio (SpO 2 /FiO 2 ratio) <4.4, and a positive troponin I. 24 The advantage in our study is that the need for IMV may be predicted without any invasive investigations like arterial blood gas or serum troponin.…”

A Discriminant Analysis of the Factors Affecting Abnormalities in Chest Computed Tomographies of 608-Group Patients with COVID-19 Pneumonia

“…The COVID-19 disease has rapid progression and causes severe symptoms 5 . Severe cases with respiratory failure require mechanical ventilation and other life supports 6 and have a lower chance of survival, and spend several weeks in the intensive care unit. These patients cannot be weaned from the ventilator, have potentially regressive performance and a higher chance of death 7,8 .…”