[en] Purpose: To describe acute respiratory distress syndrome (ARDS) severity, ventilation management, and the outcomes of ICU patients with laboratory-confirmed COVID-19 and to determine risk factors of 90-day mortality post-ICU admission.
Methods: COVID-ICU is a multi-center, prospective cohort study conducted in 138 hospitals in France, Belgium, and Switzerland. Demographic, clinical, respiratory support, adjunctive interventions, ICU length-of-stay, and survival data were collected.
Results: From February 25 to May 4, 2020, 4643 patients (median [IQR] age 63 [54-71] years and SAPS II 37 [28-50]) were admitted in ICU, with day-90 post-ICU admission status available for 4244. On ICU admission, standard oxygen therapy, high-flow oxygen, and non-invasive ventilation were applied to 29%, 19%, and 6% patients, respectively. 2635 (63%) patients were intubated during the first 24 h whereas overall 3376 (80%) received invasive mechanical ventilation (MV) at one point during their ICU stay. Median (IQR) positive end-expiratory and plateau pressures were 12 (10-14) cmH2O, and 24 (21-27) cmH2O, respectively. The mechanical power transmitted by the MV to the lung was 26.5 (18.6-34.9) J/min. Paralyzing agents and prone position were applied to 88% and 70% of patients intubated at Day-1, respectively. Pulmonary embolism and ventilator-associated pneumonia were diagnosed in 207 (9%) and 1209 (58%) of these patients. On day 90, 1298/4244 (31%) patients had died. Among patients who received invasive or non-invasive ventilation on the day of ICU admission, day-90 mortality increased with the severity of ARDS at ICU admission (30%, 34%, and 50% for mild, moderate, and severe ARDS, respectively) and decreased from 42 to 25% over the study period. Early independent predictors of 90-day mortality were older age, immunosuppression, severe obesity, diabetes, higher renal and cardiovascular SOFA score components, lower PaO2/FiO2 ratio and a shorter time between first symptoms and ICU admission.
Conclusion: Among more than 4000 critically ill patients with COVID-19 admitted to our ICUs, 90-day mortality was 31% and decreased from 42 to 25% over the study period. Mortality was higher in older, diabetic, obese and severe ARDS patients.
Disciplines :
Anesthésie & soins intensifs
Auteur, co-auteur :
LAMBERMONT, Bernard ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators
KISOKA, Grâce ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Grégoire, Céline ; Université de Liège - ULiège > Département des sciences cliniques > GIGA-R : Hématologie
Langue du document :
Anglais
Titre :
Clinical characteristics and day-90 outcomes of 4244 ctritically ill adults with COVID-19: a prospective cohort study
REVA network http://www.reseau-reva.org/. Accessed 5 Oct 2020
Grasselli G, Zangrillo A, Zanella A et al (2020) Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 10.1001/jama.2020.5394 DOI: 10.1001/jama.2020.5394
Xie J, Wu W, Li S et al (2020) Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study. Intensive Care Med. 10.1007/s00134-020-06211-2 DOI: 10.1007/s00134-020-06211-2
Cummings MJ, Baldwin MR, Abrams D et al (2020) Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 10.1016/S0140-6736(20)31189-2 DOI: 10.1016/S0140-6736(20)31189-2
Grasselli G, Greco M, Zanella A et al (2020) Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy. JAMA Intern Med, Italy. 10.1001/jamainternmed.2020.3539 DOI: 10.1001/jamainternmed.2020.3539
RECOVERY Collaborative Group, Horby P, Lim WS et al (2020) Dexamethasone in hospitalized patients with Covid-19—preliminary report. N Engl J Med. 10.1056/NEJMoa2021436 DOI: 10.1056/NEJMoa2021436
Clinical management of severe acute respiratory infection when COVID-19 is suspected. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected. Accessed 27 Apr 2020
Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963 DOI: 10.1001/jama.1993.03510240069035
Vincent JL, Moreno R, Takala J et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710 DOI: 10.1007/BF01709751
Juma S, Taabazuing M-M, Montero-Odasso M (2016) Clinical frailty scale in an acute medicine unit: a simple tool that predicts length of stay. Can Geriatr J 19:34–39. 10.5770/cgj.19.196 DOI: 10.5770/cgj.19.196
Gattinoni L, Tonetti T, Cressoni M et al (2016) Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med 42:1567–1575. 10.1007/s00134-016-4505-2 DOI: 10.1007/s00134-016-4505-2
Sinha P, Calfee CS, Beitler JR et al (2018) Physiological analysis and clinical performance of the ventilatory ratio in acute respiratory distress syndrome. Am J Respir Crit Care Med. 10.1164/rccm.201804-0692OC DOI: 10.1164/rccm.201804-0692OC
Definition Task Force ARDS, Ranieri VM, Rubenfeld GD et al (2012) Acute respiratory distress syndrome: the Berlin Definition. JAMA 307:2526–2533. 10.1001/jama.2012.5669 DOI: 10.1001/jama.2012.5669
Vincent J-L, Rello J, Marshall J et al (2009) International study of the prevalence and outcomes of infection in intensive care units. JAMA 302:2323–2329. 10.1001/jama.2009.1754 DOI: 10.1001/jama.2009.1754
Grambsch PM, Therneau TM (1994) Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81:515–526. 10.1093/biomet/81.3.515 DOI: 10.1093/biomet/81.3.515
Sterne JAC, White IR, Carlin JB et al (2009) Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 338:b2393. 10.1136/bmj.b2393 DOI: 10.1136/bmj.b2393
Bellani G, Laffey JG, Pham T et al (2016) Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 315:788–800. 10.1001/jama.2016.0291 DOI: 10.1001/jama.2016.0291
Wang D, Hu B, Hu C et al (2020) Clinical Characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 10.1001/jama.2020.1585 DOI: 10.1001/jama.2020.1585
Yang X, Yu Y, Xu J et al (2020) Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 10.1016/S2213-2600(20)30079-5 DOI: 10.1016/S2213-2600(20)30079-5
Arentz M, Yim E, Klaff L et al (2020) Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA. 10.1001/jama.2020.4326 DOI: 10.1001/jama.2020.4326
Gattinoni L, Chiumello D, Caironi P et al (2020) COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med 46:1099–1102. 10.1007/s00134-020-06033-2 DOI: 10.1007/s00134-020-06033-2
Grasselli G, Tonetti T, Protti A et al (2020) Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. Lancet Respir Med. 10.1016/S2213-2600(20)30370-2 DOI: 10.1016/S2213-2600(20)30370-2
Serpa Neto A, Deliberato RO, Johnson AEW et al (2018) Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med 44:1914–1922. 10.1007/s00134-018-5375-6 DOI: 10.1007/s00134-018-5375-6
Gattinoni L, Meissner K, Marini JJ (2020) The baby lung and the COVID-19 era. Intensive Care Med 46:1438–1440. 10.1007/s00134-020-06103-5 DOI: 10.1007/s00134-020-06103-5
Schmidt M, Hajage D, Lebreton G et al (2020) Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study. Lancet Respir Med. 10.1016/S2213-2600(20)30328-3 DOI: 10.1016/S2213-2600(20)30328-3
Millar JE, Busse R, Fraser JF et al (2020) Apples and oranges: international comparisons of COVID-19 observational studies in ICUs. Lancet Respir Med. 10.1016/S2213-2600(20)30368-4 DOI: 10.1016/S2213-2600(20)30368-4
Auld SC, Caridi-Scheible M, Robichaux C et al (2020) Declines in mortality over time for critically ill adults with coronavirus disease 2019. Crit Care Med. 10.1097/CCM.0000000000004687 DOI: 10.1097/CCM.0000000000004687
Alban A, Chick SE, Dongelmans DA et al (2020) ICU capacity management during the COVID-19 pandemic using a process simulation. Intensive Care Med 46:1624–1626. 10.1007/s00134-020-06066-7 DOI: 10.1007/s00134-020-06066-7
Gabarre P, Dumas G, Dupont T et al (2020) Acute kidney injury in critically ill patients with COVID-19. Intensive Care Med 46:1339–1348. 10.1007/s00134-020-06153-9 DOI: 10.1007/s00134-020-06153-9
https://www.santepubliquefrance.fr/les-actualites/2017/etude-esteban-2014-2016-chapitre-corpulence-stabilisation-du-surpoids-et-de-l-obesite-chez-l-enfant-et-l-adulte. Accessed 5 Oct 2020
Green WD, Beck MA (2017) Obesity impairs the adaptive immune response to influenza virus. Ann Am Thorac Soc 14:S406–S409. 10.1513/AnnalsATS.201706-447AW DOI: 10.1513/AnnalsATS.201706-447AW
Chait A, den Hartigh LJ (2020) Adipose tissue distribution, inflammation and its metabolic consequences, including diabetes and cardiovascular disease. Front Cardiovasc Med 7:22. 10.3389/fcvm.2020.00022 DOI: 10.3389/fcvm.2020.00022
Gong MN, Bajwa EK, Thompson BT, Christiani DC (2010) Body mass index is associated with the development of acute respiratory distress syndrome. Thorax 65:44–50. 10.1136/thx.2009.117572 DOI: 10.1136/thx.2009.117572
McLaren L (2007) Socioeconomic status and obesity. Epidemiol Rev 29:29–48. 10.1093/epirev/mxm001 DOI: 10.1093/epirev/mxm001
Azoulay E, Fartoukh M, Darmon M et al (2020) Increased mortality in patients with severe SARS-CoV-2 infection admitted within seven days of disease onset. Intensive Care Med. 10.1007/s00134-020-06202-3 DOI: 10.1007/s00134-020-06202-3
Poissy J, Goutay J, Caplan M et al (2020) Pulmonary embolism in COVID-19 patients: awareness of an increased prevalence. Circulation. 10.1161/CIRCULATIONAHA.120.047430 DOI: 10.1161/CIRCULATIONAHA.120.047430
Helms J, Tacquard C, Severac F et al (2020) High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 10.1007/s00134-020-06062-x DOI: 10.1007/s00134-020-06062-x
Tang N, Li D, Wang X, Sun Z (2020) Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 18:844–847. 10.1111/jth.14768 DOI: 10.1111/jth.14768
Liu Z, Long W, Tu M et al (2020) Lymphocyte subset (CD4 +, CD8 +) counts reflect the severity of infection and predict the clinical outcomes in patients with COVID-19. J Infect 81:318–356. 10.1016/j.jinf.2020.03.054 DOI: 10.1016/j.jinf.2020.03.054
Zhou F, Yu T, Du R et al (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395:1054–1062. 10.1016/S0140-6736(20)30566-3 DOI: 10.1016/S0140-6736(20)30566-3
