Long-term survival of mechanically ventilated patients
with severe COVID-19: an observational cohort study
by Oscar Peñuelas, Laura del Campo-Albendea, Amanda Lesmes
González de Aledo, José Manuel Añón, Carmen Rodríguez-Solís, Jordi Mancebo,
Paula Vera, Daniel Ballesteros, Jorge Jiménez, Emilio Maseda, Juan Carlos
Figueira, Nieves Franco, Ángela Algaba, Juan Pablo Avilés, Ricardo Díaz,
Beatriz Abad…
Annals of
Intensive Care volume 11,
Article number: 143 Published: 02
October 2021
Background
Information is lacking regarding long-term survival and
predictive factors for mortality in patients with acute hypoxemic respiratory
failure due to coronavirus disease 2019 (COVID-19) and undergoing invasive
mechanical ventilation. We aimed to estimate 180-day mortality of patients with
COVID-19 requiring invasive ventilation, and to develop a predictive model for
long-term mortality.
Methods
Retrospective, multicentre, national cohort study between
March 8 and April 30, 2020 in 16 intensive care units (ICU) in Spain.
Participants were consecutive adults who received invasive mechanical
ventilation for COVID-19. Severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) infection detected in positive testing of a nasopharyngeal sample
and confirmed by real time reverse-transcriptase polymerase chain reaction
(rt-PCR). The primary outcomes was 180-day survival after hospital admission.
Secondary outcomes were length of ICU and hospital stay, and ICU and
in-hospital mortality. A predictive model was developed to estimate the
probability of 180-day mortality.
Results
868 patients were included (median age, 64 years
[interquartile range [IQR], 56–71 years]; 72% male). Severity at ICU admission,
estimated by SAPS3, was 56 points [IQR 50–63]. Prior to intubation, 26%
received some type of noninvasive respiratory support. The unadjusted overall
180-day survival rates was 59% (95% CI 56–62%). The predictive factors measured
during ICU stay, and associated with 180-day mortality were: age [Odds Ratio
[OR] per 1-year increase 1.051, 95% CI 1.033–1.068)), SAPS3 (OR per 1-point
increase 1.027, 95% CI 1.011–1.044), diabetes (OR 1.546, 95% CI 1.085–2.204),
neutrophils to lymphocytes ratio (OR per 1-unit increase 1.008, 95% CI
1.001–1.016), failed attempt of noninvasive positive pressure ventilation prior
to orotracheal intubation (OR 1.878 (95% CI 1.124–3.140), use of selective
digestive decontamination strategy during ICU stay (OR 0.590 (95% CI
0.358–0.972) and administration of low dosage of corticosteroids (methylprednisolone
1 mg/kg) (OR 2.042 (95% CI 1.205–3.460).
Conclusion
The long-term survival of mechanically ventilated patients
with severe COVID-19 reaches more than 50% and may help to provide
individualized risk stratification and potential treatments.
