TY - JOUR
T1 - Assessment of 28-Day In-Hospital Mortality in Mechanically Ventilated Patients with Coronavirus Disease 2019
T2 - An International Cohort Study
AU - Li Bassi, Gianluigi
AU - Suen, Jacky Y.
AU - White, Nicole
AU - Dalton, Heidi J.
AU - Fanning, Jonathon
AU - Corley, Amanda
AU - Shrapnel, Sally
AU - Hinton, Samuel
AU - Forsyth, Simon
AU - Parsons, Rex
AU - Laffey, John G.
AU - Fan, Eddy
AU - Bartlett, Robert
AU - Brodie, Daniel
AU - Burrell, Aidan
AU - Chiumello, Davide
AU - Elhazmi, Alyaa
AU - Grasselli, Giacomo
AU - Hodgson, Carol
AU - Ichiba, Shingo
AU - Luna, Carlos
AU - Marwali, Eva
AU - Merson, Laura
AU - Murthy, Srinivas
AU - Nichol, Alistair
AU - Panigada, Mauro
AU - Pelosi, Paolo
AU - Torres, Antoni
AU - Ng, Pauline Yeung
AU - Ogino, Mark
AU - Fraser, John F.
AU - on behalf of the COVID-19 Critical Care Consortium
N1 - Funding Information:
Supported, in part, by grant from the University of Queensland, The Wesley Medical Research, The Prince Charles Hospital Foundation, The Health Research Board of Ireland; Biomedicine International Training Research Programme for Excellent Clinician-Scientists; The European Union Research and Innovation Programme (Horizon 2020); and La Caixa Foundation.
Funding Information:
Dr. Li Bassi received research support from Fisher & Paykel outside the submitted work. Dr. Dalton consults with Innovative Extracorporeal Membrane Oxygenation Concepts, Abiomed, and Instrumentation Laboratory, which does not affect the current work. Dr. Brodie receives research support from ALung Technologies, and he has been on the medical advisory boards for Baxter, Abiomed, Xenios, and Hemovent. Dr. Fan reports personal fees from ALung Technologies, Baxter, Fresenius Medical Care, Getinge, and MC3 Cardiopulmonary outside the submitted work. Dr. Laffey reports consulting fees from Baxter and Cala Medical, both outside the submitted work. Dr. Nichol is supported by a Health Research Board of Ireland Award (CTN-2014-012). Dr. Fraser receives research support from Fisher & Paykel outside the submitted work. Dr. Grasselli reports personal fees from Draeger Medical, Biotest, Getinge, Fisher & Paykel, and Merck Sharp & Dohme outside the submitted work. Dr. Hodgson is funded by the National Health and Medical Research Council Grant. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Publisher Copyright:
© The Author(s) 2021.
PY - 2021/11/5
Y1 - 2021/11/5
N2 - IMPORTANCE: Factors associated with mortality in coronavirus disease 2019 patients on invasive mechanical ventilation are still not fully elucidated. OBJECTIVES: To identify patient-level parameters, readily available at the bedside, associated with the risk of in-hospital mortality within 28 days from commencement of invasive mechanical ventilation or coronavirus disease 2019. DESIGN, SETTING, AND PARTICIPANTS: Prospective observational cohort study by the global Coronavirus Disease 2019 Critical Care Consortium. Patients with laboratory-confirmed coronavirus disease 2019 requiring invasive mechanical ventilation from February 2, 2020, to May 15, 2021. MAIN OUTCOMES AND MEASURES: Patient characteristics and clinical data were assessed upon ICU admission, the commencement of invasive mechanical ventilation and for 28 days thereafter. We primarily aimed to identify time-independent and time-dependent risk factors for 28-day invasive mechanical ventilation mortality. RESULTS: One-thousand five-hundred eighty-seven patients were included in the survival analysis; 588 patients died in hospital within 28 days of commencing invasive mechanical ventilation (37%). Cox-regression analysis identified associations between the hazard of 28-day invasive mechanical ventilation mortality with age (hazard ratio, 1.26 per 10-yr increase in age; 95% CI, 1.16-1.37; p < 0.001), positive end-expiratory pressure upon commencement of invasive mechanical ventilation (hazard ratio, 0.81 per 5 cm H2O increase; 95% CI, 0.67-0.97; p = 0.02). Time-dependent parameters associated with 28-day invasive mechanical ventilation mortality were serum creatinine (hazard ratio, 1.28 per doubling; 95% CI, 1.15-1.41; p < 0.001), lactate (hazard ratio, 1.22 per doubling; 95% CI, 1.11-1.34; p < 0.001), Paco2(hazard ratio, 1.63 per doubling; 95% CI, 1.19-2.25; p < 0.001), pH (hazard ratio, 0.89 per 0.1 increase; 95% CI, 0.8-14; p = 0.041), Pao2/Fio2(hazard ratio, 0.58 per doubling; 95% CI, 0.52-0.66; p < 0.001), and mean arterial pressure (hazard ratio, 0.92 per 10 mm Hg increase; 95% CI, 0.88-0.97; p = 0.003). CONCLUSIONS AND RELEVANCE: This international study suggests that in patients with coronavirus disease 2019 on invasive mechanical ventilation, older age and clinically relevant variables monitored at baseline or sequentially during the course of invasive mechanical ventilation are associated with 28-day invasive mechanical ventilation mortality hazard. Further investigation is warranted to validate any causative roles these parameters might play in influencing clinical outcomes.
AB - IMPORTANCE: Factors associated with mortality in coronavirus disease 2019 patients on invasive mechanical ventilation are still not fully elucidated. OBJECTIVES: To identify patient-level parameters, readily available at the bedside, associated with the risk of in-hospital mortality within 28 days from commencement of invasive mechanical ventilation or coronavirus disease 2019. DESIGN, SETTING, AND PARTICIPANTS: Prospective observational cohort study by the global Coronavirus Disease 2019 Critical Care Consortium. Patients with laboratory-confirmed coronavirus disease 2019 requiring invasive mechanical ventilation from February 2, 2020, to May 15, 2021. MAIN OUTCOMES AND MEASURES: Patient characteristics and clinical data were assessed upon ICU admission, the commencement of invasive mechanical ventilation and for 28 days thereafter. We primarily aimed to identify time-independent and time-dependent risk factors for 28-day invasive mechanical ventilation mortality. RESULTS: One-thousand five-hundred eighty-seven patients were included in the survival analysis; 588 patients died in hospital within 28 days of commencing invasive mechanical ventilation (37%). Cox-regression analysis identified associations between the hazard of 28-day invasive mechanical ventilation mortality with age (hazard ratio, 1.26 per 10-yr increase in age; 95% CI, 1.16-1.37; p < 0.001), positive end-expiratory pressure upon commencement of invasive mechanical ventilation (hazard ratio, 0.81 per 5 cm H2O increase; 95% CI, 0.67-0.97; p = 0.02). Time-dependent parameters associated with 28-day invasive mechanical ventilation mortality were serum creatinine (hazard ratio, 1.28 per doubling; 95% CI, 1.15-1.41; p < 0.001), lactate (hazard ratio, 1.22 per doubling; 95% CI, 1.11-1.34; p < 0.001), Paco2(hazard ratio, 1.63 per doubling; 95% CI, 1.19-2.25; p < 0.001), pH (hazard ratio, 0.89 per 0.1 increase; 95% CI, 0.8-14; p = 0.041), Pao2/Fio2(hazard ratio, 0.58 per doubling; 95% CI, 0.52-0.66; p < 0.001), and mean arterial pressure (hazard ratio, 0.92 per 10 mm Hg increase; 95% CI, 0.88-0.97; p = 0.003). CONCLUSIONS AND RELEVANCE: This international study suggests that in patients with coronavirus disease 2019 on invasive mechanical ventilation, older age and clinically relevant variables monitored at baseline or sequentially during the course of invasive mechanical ventilation are associated with 28-day invasive mechanical ventilation mortality hazard. Further investigation is warranted to validate any causative roles these parameters might play in influencing clinical outcomes.
KW - coronavirus disease 2019
KW - intensive care unit
KW - mechanical ventilation
KW - severe acute respiratory syndrome coronavirus 2
UR - http://www.scopus.com/inward/record.url?scp=85129727741&partnerID=8YFLogxK
U2 - 10.1097/CCE.0000000000000567
DO - 10.1097/CCE.0000000000000567
M3 - Article
AN - SCOPUS:85129727741
SN - 2639-8028
VL - 3
JO - Critical Care Explorations
JF - Critical Care Explorations
IS - 11
M1 - e0567
ER -