Abu Sayf Alaa, Fadel Raef, Scott Ashley, Al Bizri Layla, Kong Wing Tai, Rezik Mohamed, Joyce Katherine, Alalwan Yusuf, Dabaja Mohamed, Nair Sashi, Modi Krishna, Brar Indira, Suleyman Geehan, Swiderek Jennifer, Tatem Geneva, Miller Joseph, Grafton Gillian, Ouellette Daniel R
Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI.
Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.
Crit Care Explor. 2021 Mar 26;3(4):e0377. doi: 10.1097/CCE.0000000000000377. eCollection 2021 Apr.
To investigate the differences in clinical course, ventilator mechanics, and outcomes of patients with coronavirus disease 2019 secondary to acute respiratory distress syndrome infection compared with a historical cohort of acute respiratory distress syndrome.
Comparative case-control study.
Multicenter, comprehensive tertiary healthcare facility in Detroit, MI.
PATIENTS/SUBJECTS: Adult patients hospitalized with coronavirus disease 2019 secondary to acute respiratory distress syndrome infection were compared with patients hospitalized with acute respiratory distress syndrome prior to the coronavirus disease 2019 pandemic (control).
None.
We included 384 patients in the analysis. Inpatient mortality was significantly higher in patients with coronavirus disease 2019 secondary to acute respiratory distress syndrome infection compared with controls (64% vs 49%; = 0.007). Despite both groups demonstrating similar ventilatory function and Sequential Organ Failure Assessment score on day 1 of intubation, with similar lung compliance throughout the study period, patients with coronavirus disease 2019 secondary to acute respiratory distress syndrome infection demonstrated progressive hypoxia compared with controls across the study period. Similarly, higher positive end-expiratory pressure levels and increased use of paralytics were observed in the patients with coronavirus disease 2019 secondary to acute respiratory distress syndrome infection group. On univariate analysis of the entire cohort, significant risk factors for inpatient mortality included coronavirus disease 2019 infection ( = 0.007), older age ( < 0.001), high Sequential Organ Failure Assessment score ( = 0.003), vasopressor use ( = 0.039), paralytic use ( < 0.001), higher positive end-expiratory pressure levels on day 3 ( = 0.027) and day 7 ( < 0.001), in addition to acute respiratory distress syndrome severity on both days 3 ( = 0.008) and 7 ( < 0.001). Multivariate analysis identified coronavirus disease 2019 infection (odds ratio, 1.939; = 0.021), older age (odds ratio, 1.042; < 0.001), paralytic use (odds ratio, 3.366; < 0.001), and higher Sequential Organ Failure Assessment score (odds ratio, 1.152; = 0.027) as significant predictors of mortality across the entire cohort.
Patients with coronavirus disease 2019 secondary to acute respiratory distress syndrome infection demonstrated higher mortality compared with control patients hospitalized with acute respiratory distress syndrome prior to the pandemic, with progressive hypoxia throughout the study period, despite similar lung mechanics and initial Sequential Organ Failure Assessment score. Coronavirus disease 2019 infection, older age, paralytic use, and higher Sequential Organ Failure Assessment scores were independent risk factors for 28-day mortality across the entire cohort.
研究2019冠状病毒病继发急性呼吸窘迫综合征感染患者与急性呼吸窘迫综合征历史队列患者在临床病程、呼吸机力学及预后方面的差异。
比较性病例对照研究。
密歇根州底特律的多中心综合性三级医疗保健机构。
患者/受试者：将因2019冠状病毒病继发急性呼吸窘迫综合征感染住院的成年患者与2019冠状病毒病大流行之前因急性呼吸窘迫综合征住院的患者（对照）进行比较。
无。
我们纳入了384例患者进行分析。与对照组相比，2019冠状病毒病继发急性呼吸窘迫综合征感染患者的住院死亡率显著更高（64% 对49%；P = 0.007）。尽管两组在插管第1天的通气功能和序贯器官衰竭评估评分相似，且在整个研究期间肺顺应性相似，但2019冠状病毒病继发急性呼吸窘迫综合征感染患者在整个研究期间与对照组相比出现了进行性低氧血症。同样，在2019冠状病毒病继发急性呼吸窘迫综合征感染组患者中观察到更高的呼气末正压水平和更多地使用了麻痹剂。对整个队列进行单因素分析时，住院死亡率的显著危险因素包括2019冠状病毒病感染（P = 0.007）、年龄较大（P < 0.001）、序贯器官衰竭评估评分高（P = 0.003）、使用血管活性药物（P = 0.039）、使用麻痹剂（P < 0.001）、第3天（P = 0.027）和第7天（P < 0.001）更高的呼气末正压水平，以及第3天（P = 0.008）和第7天（P < 0.001）的急性呼吸窘迫综合征严重程度。多因素分析确定2019冠状病毒病感染（比值比，1.939；P = 0.021）、年龄较大（比值比，1.042；P < 0.001）、使用麻痹剂（比值比，3.366；P < 0.001）和更高的序贯器官衰竭评估评分（比值比，1.152；P = 0.027）是整个队列死亡率的显著预测因素。
与大流行之前因急性呼吸窘迫综合征住院的对照患者相比，2019冠状病毒病继发急性呼吸窘迫综合征感染患者的死亡率更高，尽管肺力学和初始序贯器官衰竭评估评分相似，但在整个研究期间仍出现进行性低氧血症。2019冠状病毒病感染、年龄较大、使用麻痹剂和更高的序贯器官衰竭评估评分是整个队列28天死亡率的独立危险因素。
