Time course of risk factors associated with mortality of 1260 critically ill patients with COVID-19 admitted to 24 Italian intensive care units

• Published in: Intensive care medicine Vol. 47; no. 9; pp. 995 - 1008
• Main Authors: Zanella, Alberto, Florio, Gaetano, Antonelli, Massimo, Bellani, Giacomo, Berselli, Angela, Bove, Tiziana, Cabrini, Luca, Carlesso, Eleonora, Castelli, Gian Paolo, Cecconi, Maurizio, Citerio, Giuseppe, Coloretti, Irene, Corti, Daniele, Dalla Corte, Francesca, De Robertis, Edoardo, Foti, Giuseppe, Fumagalli, Roberto, Girardis, Massimo, Giudici, Riccardo, Guiotto, Lorenzo, Langer, Thomas, Mirabella, Lucia, Pasero, Daniela, Protti, Alessandro, Ranieri, Marco V., Rona, Roberto, Scudeller, Luigia, Severgnini, Paolo, Spadaro, Savino, Stocchetti, Nino, Viganò, Martina, Pesenti, Antonio, Grasselli, Giacomo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2021; Springer; Springer Nature B.V
• Subjects: Aged; Anesthesiology; Bilirubin; Blood pressure; C-reactive protein; Carbon dioxide; China; Coagulation; Coronavirus; Coronaviruses; COVID-19; Creatinine; Critical Care Medicine; Critical Illness; Emergency Medicine; Ferritin; Health risks; Hospital patients; Hospitals; Humans; Intensive; Intensive care; Intensive Care Units; Italy; Lactic acid; Leukocytes (neutrophilic); Lymphocytes; Male; Mechanical ventilation; Medicine; Medicine & Public Health; Middle Aged; Mortality; NCT; NCT04388670; Neutrophils; Original; Oxygen; Pain Medicine; Parameters; Partial pressure; Patient outcomes; Patients; Pediatrics; Platelets; Pneumology/Respiratory System; Polynomials; Prospective Studies; Proteins; Regression models; Respiration, Artificial; Respiratory system; Retrospective Studies; Risk analysis; Risk Factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Survival; Trends; United Kingdom; Urea; Viral diseases; Italy; United Kingdom; China; COVID-19; Time course; Mortality; Intensive care unit; Longitudinal models; Predictors
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-021-06495-y

Purpose To evaluate the daily values and trends over time of relevant clinical, ventilatory and laboratory parameters during the intensive care unit (ICU) stay and their association with outcome in critically ill patients with coronavirus disease 19 (COVID-19). Methods In this retrospective–prospective multicentric study, we enrolled COVID-19 patients admitted to Italian ICUs from February 22 to May 31, 2020. Clinical data were daily recorded. The time course of 18 clinical parameters was evaluated by a polynomial maximum likelihood multilevel linear regression model, while a full joint modeling was fit to study the association with ICU outcome. Results 1260 consecutive critically ill patients with COVID-19 admitted in 24 ICUs were enrolled. 78% were male with a median age of 63 [55–69] years. At ICU admission, the median ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO 2 /FiO 2 ) was 122 [89–175] mmHg. 79% of patients underwent invasive mechanical ventilation. The overall mortality was 34%. Both the daily values and trends of respiratory system compliance, PaO 2 /FiO 2 , driving pressure, arterial carbon dioxide partial pressure, creatinine, C-reactive protein, ferritin, neutrophil, neutrophil–lymphocyte ratio, and platelets were associated with survival, while for lactate, pH, bilirubin, lymphocyte, and urea only the daily values were associated with survival. The trends of PaO 2 /FiO 2 , respiratory system compliance, driving pressure, creatinine, ferritin, and C-reactive protein showed a higher association with survival compared to the daily values. Conclusion Daily values or trends over time of parameters associated with acute organ dysfunction, acid–base derangement, coagulation impairment, or systemic inflammation were associated with patient survival.