Predictors of Mortality in Critically Ill COVID-19 Patients Demanding High Oxygen Flow: A Thin Line between Inflammation, Cytokine Storm, and Coagulopathy

Abstract

Introduction. Mortality among critically ill COVID-19 patients remains relatively high despite different potential therapeutic modalities being introduced recently. The treatment of critically ill patients is a challenging task, without identified credible predictors of mortality. Methods. We performed an analysis of 160 consecutive patients with confirmed COVID-19 infection admitted to the Respiratory Intensive Care Unit between June 23, 2020, and October 2, 2020, in University Hospital Center Bezanijska kosa, Belgrade, Serbia. Patients on invasive, noninvasive ventilation and high flow oxygen therapy with moderate to severe ARDS, according to the Berlin definition of ARDS, were selected for the study. Demographic data, past medical history, laboratory values, and CT severity score were analyzed to identify predictors of mortality. Univariate and multivariate logistic regression models were used to assess potential predictors of mortality in critically ill COVID-19 patients. Results. The mean patient age was 65.6 years (range, 29–92 years), predominantly men, 68.8%. 107 (66.9%) patients were on invasive mechanical ventilation, 31 (19.3%) on noninvasive, and 22 (13.8%) on high flow oxygen therapy machine. The median total number of ICU days was 10 (25th to 75th percentile: 6–18), while the median total number of hospital stay was 18 (25th to 75th percentile: 12–28). The mortality rate was 60% (96/160). Univariate logistic regression analysis confirmed the significance of age, CRP, and lymphocytes at admission to hospital, serum albumin, D-dimer, and IL-6 at admission to ICU, and CT score. Serum albumin, D-dimer, and IL-6 at admission to ICU were independently associated with mortality in the final multivariate analysis. Conclusion. In the present study of 160 consecutive critically ill COVID-19 patients with moderate to severe ARDS, IL-6, serum albumin, and D-dimer at admission to ICU, accompanied by chest CT severity score, were marked as independent predictors of mortality.

The Female-Predominant Persistent Immune Dysregulation of the Post-COVID Syndrome

“… 23 Not surprisingly, there has been similar interest in the cytokine release syndrome (CRS) attributed to severe cases of COVID-19, especially in regard to IL-6. 24 The potential overlap between the inflammatory response of CS and PASC has not yet been determined.…”

Development and Validation of a Multivariable Predictive Model for Mortality of COVID-19 Patients Demanding High Oxygen Flow at Admission to ICU: AIDA Score

“…In the derivation cohort, the following variables were associated with the mortality of patients admitted to ICU due to COVID-19-related pneumonia in univariate logistic regression analysis: age (RR = 3.495, 95% CI 1.801–6.779), albumin (RR = 22.286, 95% CI 9.319–53.294), D-dimer (RR = 2.111, 95% CI 1.091–4.085), IL-6 at admission to ICU (RR = 6.100, 95% CI 2.857–13.023), and CT score (RR = 2.362, 95% CI 1.120–4.980). In the multivariate analysis, serum albumin (RR = 25.740, 95% CI 7.491–88.443), IL-6 (RR = 6.245, 95% CI 1.937–20.129), and D-dimer at admission to ICU (RR = 4.574, 95% CI 1.375–15.212) were independently associated with mortality [ 17 ]. Subsequently, the regression coefficients from the final multivariate model were used to assign points for the risk model.…”

“…The AIDA score was developed according to the results and methodology of the previous study by Popadic et al [ 17 ], combining all significant variables from the multivariate logistic regression analysis including serum albumin, interleukin-6, and D-dimer, accompanied by age.…”

“…The derivation group consisted of 160 COVID-19 patients with moderate to severe ARDS admitted to the Respiratory Intensive Care Unit between June 23, 2020, and October 2, 2020, in University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia, while further analysis and validation were performed on additional consecutive 318 patients admitted to ICU between October 2, 2020, and January 14, 2021, in University Clinical Hospital Center Bezanijska kosa, Belgrade, Serbia (160 patients), and University Clinical Hospital Center Zvezdara, Belgrade, Serbia (158 patients). The patients in both groups were treated by the National Protocol of the Republic of Serbia for the treatment of COVID-19 infection, as explained in Materials and Methods of the development study by Popadic et al [ 17 ].…”

Evaluation of the Use of Blood Products in ICU Hospitalized COVID-19 Patients

“…Patients were treated according to the adjusted National Protocol of the Republic of Serbia for the treatment of COVID-19 infection, which included anticoagulants in standard prophylactic or therapeutic doses among other applied therapies. The indication for convalescent plasma was established by a specific scoring system according to the same national protocol [16]. Illness severity was defined by the WHO Clinical Management of COVID-19 guidance.…”