Risk factors of death in mechanically ventilated COVID-19 patients: a retrospective multi- center study
Mohammadreza Salehi, Mohammad-Taghi Beig Mohammadi, Seyed Hamidreza Abtahi, Samrand-Fattah Ghazi, Abolfazl Sobati, Rama Bozorgmehr, Seyed Ali Dehghan Manshadi, Saeed Reza Jamali Siahkali, Mostafa Mohammadi, Banafsheh Moradmand Badie, Ensiyeh Rahimi
doi:10.21203/rs.3.rs-1362678/v1
Introduction: Despite the improvement in COVID-19 therapeutic management the mortality of mechanically ventilated COVID-19 patients remains high. In this study, we determined risk factors of mortality in these cases. Methods: This retrospective study examined clinical and paraclinical data of COVID-19 patients mechanically ventilated at the time of hospitalization to ICU admission until death or discharge from hospital between April and September in 2021 in three COVID-19 referral hospitals. Results: One hundred twenty-ve patients (60% male, mean age 62 ± 15.18, range 17 to 97 years old) were recruited to this study. 51(40%) survived and 74 (60%) didn't survive. At the time of hospital admission, the vital signs were not signi cantly different between the survivors and non-survivors groups, also diarrhea was not reported in non-survivors, but reported in 9.5% of survivors (P = 0.02). The mean age of 74 non-survivors was higher than 51 survivors (65.1 ± 14.17 vs 56.9 ± 15.41, P = 0.003). The intubation time since the patients were admitted to hospitals was not signi cantly different between the two groups (3.38 ± 2.88 days vs 4.16 ± 3.42 days, P = 0.34). The mean LDH and D-dimer at the time of ICU admission were signi cantly higher in the non-survivors group (863 ± 449 vs 613 ± 326, P = 0.01; 4081 ± 3342 vs 542 ± 634, P = 0.009; respectively). However, the mean CRP was not signi cantly different between the two groups (76 ± 66.4, 54 ± 84.3; P = 0.1). Mean APACHE-II score was higher in the non-survivors than the survivors (15 vs 13; P = 0.01). Use of remdesivir, interfrone beta-1a, and low dose corticosteroids were signi cantly higher in the survivors group (P = 0.009, P = 0.001, P = 0.000). Conclusion: Success of weaning and hospital discharge among mechanically ventilated COVID-19 patients are probably higher in younger patients with lower D-dimmer and LDH levels that received low dose corticosteroids during treatment.
The study is retrospective. It was not possible to use written consent. According to the Medical Ethics Committee, patients' information remains con dential. Patients agreed to receive routine treatment upon arrival at the hospital. Then they received the treatment they needed. Finally, they were analyzed based on the treatment received in different groups.
Consent for publication: We the authors give our consent for the publication of identi able details within the text to be published in the Journal of Critical Care.
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DOI record:
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"abstract": "<jats:title>Abstract</jats:title>\n <jats:p><jats:bold>Introduction</jats:bold>: Despite the improvement in COVID-19 therapeutic management the mortality of mechanically ventilated COVID-19 patients remains high. In this study, we determined risk factors of mortality in these cases. <jats:bold>Methods</jats:bold>: This retrospective study examined clinical and paraclinical data of COVID-19 patients mechanically ventilated at the time of hospitalization to ICU admission until death or discharge from hospital between April and September in 2021 in three COVID-19 referral hospitals. <jats:bold>Results</jats:bold>: One hundred twenty-five patients (60% male, mean age 62 ± 15.18, range 17 to 97 years old) were recruited to this study. 51(40%) survived and 74 (60%) didn’t survive. At the time of hospital admission, the vital signs were not significantly different between the survivors and non-survivors groups, also diarrhea was not reported in non-survivors, but reported in 9.5% of survivors (P = 0.02). The mean age of 74 non-survivors was higher than 51 survivors (65.1 ± 14.17 vs 56.9 ± 15.41, P = 0.003). The intubation time since the patients were admitted to hospitals was not significantly different between the two groups (3.38 ± 2.88 days vs 4.16 ± 3.42 days, P = 0.34). The mean LDH and D-dimer at the time of ICU admission were significantly higher in the non-survivors group (863 ± 449 vs 613 ± 326, P = 0.01; 4081 ± 3342 vs 542 ± 634, P = 0.009; respectively). However, the mean CRP was not significantly different between the two groups (76 ± 66.4, 54 ± 84.3; P = 0.1). Mean APACHE-II score was higher in the non-survivors than the survivors (15 vs 13; P = 0.01). Use of remdesivir, interfrone beta-1a, and low dose corticosteroids were significantly higher in the survivors group (P = 0.009, P = 0.001, P = 0.000). <jats:bold>Conclusion</jats:bold>: Success of weaning and hospital discharge among mechanically ventilated COVID-19 patients are probably higher in younger patients with lower D-dimmer and LDH levels that received low dose corticosteroids during treatment.</jats:p>",
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