Factors Linked to Mortality in Invasively Ventilated Patients With COVID-19

Hypertension and obesity were the main comorbidities of patients with COVID-19 requiring invasive ventilation in Argentina, according to findings of the SATICOVID19 study (ClinicalTrials.gov Identifier: NCT04611269) recently published in Lancet Respiratory Medicine.

This multicenter, prospective study examined the associations between clinical characteristics and outcomes in 1909 adults requiring invasive ventilation for COVID-19 in 63 intensive care units (ICUs) in Argentina. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included ICU mortality, duration of invasive mechanical ventilation, patterns of change in physiological respiratory, and other independent predictors of mortality and mechanical ventilation variables.

Among the 1909 invasively ventilated patients with COVID-19 in the cohort, the median age was 62 years and 67.8% of the population were male. When comorbidities were examined, hypertension and obesity were the main comorbidities. Acute respiratory distress syndrome developed in 87.6% of patients, and 61.6% received prone positioning. Overall, in-hospital mortality was 57.7% and ICU mortality was 57.0%. Age, endotracheal intubation outside of the ICU, vasopressor use on day 1, D-dimer concentration, arterial pH on day 1, driving pressure on day 1, acute kidney injury, and month of admission were identified  as independent predictors of mortality.

The study authors wrote, “[S]igns of early organ dysfunction (ie, alterations in oxygenation, presence of hypotension, acidosis, acute kidney injury, and activation of coagulation) appear to be a prognostic factor in severe COVID-19.” They added, “We also found a paradoxical increase in mortality throughout the first wave of the pandemic, possibly reflecting increasing strain on the health-care system. Long duration of mechanical ventilation and prolonged ICU stay contributed to the pressure on ICU capacity.”

Reference

Estenssoro E, Loudet CI, Ríos FG, et al. Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina (SATICOVID): a prospective, multicentre cohort study. Lancet Respir Med. 2021;9(9):989-998. doi:10.1016/S2213-2600(21)00229-0

This article originally appeared on Pulmonology Advisor