Characterisation and outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: a single-centre experience

• Published in: BMJ open respiratory research Vol. 7; no. 1; p. e000731
• Main Authors: Mahida, Rahul Y, Chotalia, Minesh, Alderman, Joseph, Patel, Chhaya, Hayden, Amber, Desai, Ruchi, Beesley, Emily, Crowley, Louise E, Soltan, Marina, Bangash, Mansoor, Parekh, Dhruv, Patel, Jaimin, Thickett, David R
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 30.11.2020; BMJ Publishing Group
• Subjects: C-Reactive Protein - metabolism; Cardiovascular disease; Chronic obstructive pulmonary disease; Cohort Studies; COVID-19 - complications; Critical Care; Critical Care - methods; Diabetes; Ethnicity; Ethnicity - statistics & numerical data; Female; Humans; Intensive care; Kidney diseases; Laboratories; Leukocytes - metabolism; Male; Middle Aged; Monocytes - metabolism; Mortality; Neutrophils - metabolism; Ostomy; Pandemics; Patient Outcome Assessment; Patients; Physiology; Pneumonia; Respiration, Artificial - statistics & numerical data; Respiratory distress syndrome; Respiratory Distress Syndrome - blood; Respiratory Distress Syndrome - etiology; Respiratory Distress Syndrome - therapy; Respiratory Mechanics; Retrospective Studies; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Time; United Kingdom; Vasoconstrictor Agents - therapeutic use; Ventilators; Viral infections; United Kingdom; United Kingdom > UK; pneumonia; ARDS; viral infection
• ISSN: 2052-4439; 2052-4439
• DOI: 10.1136/bmjresp-2020-000731

IntroductionAcute respiratory distress syndrome (ARDS) is the major cause of mortality in patients with SARS-CoV-2 pneumonia. It appears that development of ‘cytokine storm’ in patients with SARS-CoV-2 pneumonia precipitates progression to ARDS. However, severity scores on admission do not predict severity or mortality in patients with SARS-CoV-2 pneumonia. Our objective was to determine whether patients with SARS-CoV-2 ARDS are clinically distinct, therefore requiring alternative management strategies, compared with other patients with ARDS. We report a single-centre retrospective study comparing the characteristics and outcomes of patients with ARDS with and without SARS-CoV-2.MethodsTwo intensive care unit (ICU) cohorts of patients at the Queen Elizabeth Hospital Birmingham were analysed: SARS-CoV-2 patients admitted between 11 March and 21 April 2020 and all patients with community-acquired pneumonia (CAP) from bacterial or viral infection who developed ARDS between 1 January 2017 and 1 November 2019. All data were routinely collected on the hospital’s electronic patient records.ResultsA greater proportion of SARS-CoV-2 patients were from an Asian ethnic group (p=0.002). SARS-CoV-2 patients had lower circulating leucocytes, neutrophils and monocytes (p<0.0001), but higher CRP (p=0.016) on ICU admission. SARS-CoV-2 patients required a longer duration of mechanical ventilation (p=0.01), but had lower vasopressor requirements (p=0.016).DiscussionThe clinical syndromes and respiratory mechanics of SARS-CoV-2 and CAP-ARDS are broadly similar. However, SARS-CoV-2 patients initially have a lower requirement for vasopressor support, fewer circulating leukocytes and require prolonged ventilation support. Further studies are required to determine whether the dysregulated inflammation observed in SARS-CoV-2 ARDS may contribute to the increased duration of respiratory failure.