Clinical course and outcome of COVID-19 acute respiratory distress syndrome: data from a national repository

{ 'institution': [{'name': 'medRxiv'}], 'indexed': { 'date-parts': [[2022, 11, 24]], 'date-time': '2022-11-24T16:33:39Z', 'timestamp': 1669307619765}, 'posted': {'date-parts': [[2020, 10, 20]]}, 'group-title': 'Intensive Care and Critical Care Medicine', 'reference-count': 44, 'publisher': 'Cold Spring Harbor Laboratory', 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'accepted': {'date-parts': [[2020, 10, 20]]}, 'abstract': '<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Mortality ' 'attributable to coronavirus disease-19 (COVID-19) 2 infection occurs mainly through the ' 'development of viral pneumonia-induced acute respiratory distress syndrome ' '(ARDS).</jats:p></jats:sec><jats:sec><jats:title>Research Question</jats:title><jats:p>The ' 'objective of the study is to delineate the clinical profile, predictors of disease ' 'progression, and 30-day mortality from ARDS using the Veterans Affairs Corporate Data ' 'Warehouse.</jats:p></jats:sec><jats:sec><jats:title>Study Design and ' 'Methods</jats:title><jats:p>Analysis of a historical cohort of 7,816 hospitalized patients ' 'with confirmed COVID-19 infection between January 1, 2020, and August 1, 2020. Main outcomes ' 'were progression to ARDS and 30-day mortality from ARDS, ' 'respectively.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The cohort ' 'was comprised predominantly of men (94.5%) with a median age of 69 years (interquartile range ' '[IQR] 60-74 years). 2,184 (28%) were admitted to the intensive care unit and 643 (29.4%) were ' 'diagnosed with ARDS. The median Charlson Index was 3 (IQR 1-5). Independent predictors of ' 'progression to ARDS were body mass index (BMI)≥ 40 kg/m<jats:sup>2</jats:sup>, diabetes, ' 'lymphocyte counts&lt;700×109/L, LDH&gt;450 U/L, ferritin &gt;862 ng/ml, C-reactive protein ' '&gt;11 mg/dL, and D-dimer &gt;1.5 ug/ml. In contrast, the use of an anticoagulant lowered the ' 'risk of developing ARDS (OR 0.66 [95% CI 0.49-0.89]. Crude 30-day mortality rate from ARDS ' 'was 41% (95% CI 38%-45%). Risk of death from ARDS was significantly higher in those who ' 'developed acute renal failure and septic shock. Use of an anticoagulant was associated with ' 'two-fold reduction in mortality. Survival benefit was observed in patients who received ' 'corticosteroids and/or remdesivir but there was no advantage of combination therapy over ' 'either agent ' 'alone.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Among those ' 'hospitalized for COVID-19, nearly one in ten progressed to ARDS. Septic shock, and acute ' 'renal failure are the leading causes of death in these patients. Treatment with either ' 'remdesivir and corticosteroids reduced the risk of mortality from ARDS. All hospitalized ' 'patients with COVID-19 should be placed at a minimum on prophylactic doses of ' 'anticoagulation.</jats:p></jats:sec>', 'DOI': '10.1101/2020.10.16.20214130', 'type': 'posted-content', 'created': { 'date-parts': [[2020, 10, 20]], 'date-time': '2020-10-20T23:20:32Z', 'timestamp': 1603236032000}, 'source': 'Crossref', 'is-referenced-by-count': 2, 'title': 'CLINICAL COURSE AND OUTCOME OF COVID-19 ACUTE RESPIRATORY DISTRESS SYNDROME: DATA FROM A ' 'NATIONAL REPOSITORY', 'prefix': '10.1101', 'author': [ { 'ORCID': 'http://orcid.org/0000-0003-4237-8776', 'authenticated-orcid': False, 'given': 'Ali A.', 'family': 'El-Solh', 'sequence': 'first', 'affiliation': []}, {'given': 'Umberto G.', 'family': 'Meduri', 'sequence': 'additional', 'affiliation': []}, {'given': 'Yolanda', 'family': 'Lawson', 'sequence': 'additional', 'affiliation': []}, {'given': 'Michael', 'family': 'Carter', 'sequence': 'additional', 'affiliation': []}, {'given': 'Kari A.', 'family': 'Mergenhagen', 'sequence': 'additional', 'affiliation': []}], 'member': '246', 'reference': [ { 'key': '2020102212050594000_2020.10.16.20214130v1.1', 'unstructured': 'Statistics NCfH. 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