Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

Clinical Characteristics and Determinants of Mortality in Covid19-Patients on an Intensive Care Unit – A One-Year All-Comers Study with a Focus on Non-Invasive Ventilation
W. Brücker1, A.-A. Mahabadi2, A. Hüschen1, J. Becker3, S. Daehnke3, S. Möhlenkamp1
1Kardiologie, Krankenhaus Bethanien Moers, Moers; 2Klinik für Kardiologie und Angiologie, Universitätsklinikum Essen, Essen; 3Klinik für Anästhesiologie und Operative Intensivmedizin, Moers;

Background: Clinical outcome in patients with corona virus disease 2019 (Covid-19) requiring treatment on intensive care units (ICU) remains unfavourable. At our insti­tution, most patients are initially treated outside ICU, partly using non-invasive venti­lation (NIV). The aim of this study was to explanatively identify potential predictors of unfavourable outcome in this setting in ICU patients diagnosed with Covid-19.

Methods: In all patients (55.7% male, aged 66.4±13.3 years) with Covid-19 (n=50) or SARS-CoV-2 infection as comorbidity (n=11) admitted between 03/20-03/21 to our ICU we assessed clinical, respiratory and laboratory parameters that have a poten­tial role for outcome. Main outcome variables were intubation and mortality rates.

Results: 73.8% of patients were admitted with moderate or severe acute respiratory distress syndrome (ARDS). Covid-19 patients differed clinically considerably from those with SARS-CoV-2-infection despite similar mortality rates (44.0% vs. 45.5%, p>0.5). Among Covid-19 patients, those who died had more often severe ARDS (91% vs. 46%, p=0.001), longer NIV therapy prior to ICU (6.3±5.9 vs. 2.5±2.0, p=0.046), and higher Il-6- and LDH-values as compared to survivors. In multivariable analysis, NIV-duration ≥5 days on admission (OR: 42.2 (1.2->99), p=0.038) and IL-6 (OR: 4.1 (1.2-14.3), p=0.028) remained independently predictive of mortality. In worsening tertiles of pO2/FiO2 on admission (≥161.5, 96.5-<161.5, <96.5) a stepwise increase in intubation rates (p=0.0034) and mortality rates (p=0.031) was observed.

Conclusion: Patients with SARS-CoV-2 as comorbidity differ from Covid-19 patients.  As inflammation, ARDS severity and longer NIV duration prior to ICU are associated with intubation and mortality rates, prognosis appears to be largely determined by disease severity. Whether NIV aggravates ARDS or if it indicates lack of recovery indepen­dent from type of ventilation, or both should be clarified in a prospective trial.

https://dgk.org/kongress_programme/ht2021/P967.htm