Assessment of 28-Day In-Hospital Mortality in Mechanically Ventilated Patients With Coronavirus Disease 2019: An International Cohort Study

Gianluigi Li Bassi; Jacky Y Suen; Nicole White; Heidi J Dalton; Jonathon Fanning; Amanda Corley; Sally Shrapnel; Samuel Hinton; Simon Forsyth; Rex Parsons; John G Laffey; Eddy Fan; Robert Bartlett; Daniel Brodie; Aidan Burrell; Davide Chiumello; Alyaa Elhazmi; Giacomo Grasselli; Carol Hodgson; Shingo Ichiba; Carlos Luna; Eva Marwali; Laura Merson; Srinivas Murthy; Alistair Nichol; Mauro Panigada; Paolo Pelosi; Antoni Torres; Pauline Yeung Ng; Mark Ogino; John F Fraser

doi:10.1097/CCE.0000000000000567

Assessment of 28-Day In-Hospital Mortality in Mechanically Ventilated Patients With Coronavirus Disease 2019: An International Cohort Study

Crit Care Explor. 2021 Nov 5;3(11):e0567. doi: 10.1097/CCE.0000000000000567. eCollection 2021 Nov.

Authors

Gianluigi Li Bassi^{1

2

3

4

5}, Jacky Y Suen^{1

2}, Nicole White⁶, Heidi J Dalton⁷, Jonathon Fanning^{1

2

5

8}, Amanda Corley^{1

2}, Sally Shrapnel^{2

9}, Samuel Hinton², Simon Forsyth², Rex Parsons⁶, John G Laffey^{10

11}, Eddy Fan¹², Robert Bartlett¹³, Daniel Brodie¹⁴, Aidan Burrell^{15

16}, Davide Chiumello^{17

18}, Alyaa Elhazmi¹⁹, Giacomo Grasselli^{18

20}, Carol Hodgson²¹, Shingo Ichiba²², Carlos Luna²³, Eva Marwali²⁴, Laura Merson²⁵, Srinivas Murthy²⁶, Alistair Nichol^{21

27}, Mauro Panigada²⁰, Paolo Pelosi^{28

29}, Antoni Torres^{3

30}, Pauline Yeung Ng³¹, Mark Ogino³², John F Fraser^{1

2

3

4

5}

Affiliations

¹ Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.
² University of Queensland, Brisbane, QLD, Australia.
³ Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
⁴ Queensland University of Technology, Brisbane, QLD, Australia.
⁵ St Andrew's War Memorial Hospital and Wesley Hospital, UnitingCare Hospitals, Brisbane, QLD, Australia.
⁶ Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
⁷ INOVA Fairfax Medical Center, Heart and Vascular Institute, Falls Church, VA.
⁸ Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
⁹ The Australian Research Council Centre of Excellence for Engineered Quantum Systems (EQUS, CE170100009), St. Lucia, QLD, Australia.
¹⁰ Anaesthesia and Intensive Care Medicine, School of Medicine, National University of Ireland, Galway, Ireland.
¹¹ Galway University Hospitals, Galway, Ireland.
¹² Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
¹³ University of Michigan Medical Center, Ann Arbor, MI.
¹⁴ Medical Intensive Care Unit, Department of Medicine, Columbia College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY.
¹⁵ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive, Melbourne, VIC, Australia.
¹⁶ Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia.
¹⁷ Ospedale San Paolo, Milan, Italy.
¹⁸ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
¹⁹ King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
²⁰ Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
²¹ Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, VIC, Australia.
²² Nippon Medical School Hospital, Tokyo, Japan.
²³ Neumonología, Hospital de Clínicas, UBA, Buenos Aires, Argentina.
²⁴ Pediatric Cardiac ICU, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
²⁵ University of Oxford, Oxford, United Kingdom.
²⁶ Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
²⁷ University College Dublin-Clinical Research Centre at St Vincent's University Hospital, Dublin, Ireland.
²⁸ Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
²⁹ Anaesthesiology and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.
³⁰ Hospital Clinic of Barcelona, Barcelona, Spain.
³¹ Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Hong Kong, China.
³² Nemours Alfred I duPont Hospital for Children, Wilmington, DE.

Abstract

Factors associated with mortality in coronavirus disease 2019 patients on invasive mechanical ventilation are still not fully elucidated.

Objectives: To identify patient-level parameters, readily available at the bedside, associated with the risk of in-hospital mortality within 28 days from commencement of invasive mechanical ventilation or coronavirus disease 2019.

Design setting and participants: Prospective observational cohort study by the global Coronavirus Disease 2019 Critical Care Consortium. Patients with laboratory-confirmed coronavirus disease 2019 requiring invasive mechanical ventilation from February 2, 2020, to May 15, 2021.

Main outcomes and measures: Patient characteristics and clinical data were assessed upon ICU admission, the commencement of invasive mechanical ventilation and for 28 days thereafter. We primarily aimed to identify time-independent and time-dependent risk factors for 28-day invasive mechanical ventilation mortality.

Results: One-thousand five-hundred eighty-seven patients were included in the survival analysis; 588 patients died in hospital within 28 days of commencing invasive mechanical ventilation (37%). Cox-regression analysis identified associations between the hazard of 28-day invasive mechanical ventilation mortality with age (hazard ratio, 1.26 per 10-yr increase in age; 95% CI, 1.16-1.37; p < 0.001), positive end-expiratory pressure upon commencement of invasive mechanical ventilation (hazard ratio, 0.81 per 5 cm H₂O increase; 95% CI, 0.67-0.97; p = 0.02). Time-dependent parameters associated with 28-day invasive mechanical ventilation mortality were serum creatinine (hazard ratio, 1.28 per doubling; 95% CI, 1.15-1.41; p < 0.001), lactate (hazard ratio, 1.22 per doubling; 95% CI, 1.11-1.34; p < 0.001), Paco₂ (hazard ratio, 1.63 per doubling; 95% CI, 1.19-2.25; p < 0.001), pH (hazard ratio, 0.89 per 0.1 increase; 95% CI, 0.8-14; p = 0.041), Pao₂/Fio₂ (hazard ratio, 0.58 per doubling; 95% CI, 0.52-0.66; p < 0.001), and mean arterial pressure (hazard ratio, 0.92 per 10 mm Hg increase; 95% CI, 0.88-0.97; p = 0.003).

Conclusions and relevance: This international study suggests that in patients with coronavirus disease 2019 on invasive mechanical ventilation, older age and clinically relevant variables monitored at baseline or sequentially during the course of invasive mechanical ventilation are associated with 28-day invasive mechanical ventilation mortality hazard. Further investigation is warranted to validate any causative roles these parameters might play in influencing clinical outcomes.

Keywords: coronavirus disease 2019; intensive care unit; mechanical ventilation; severe acute respiratory syndrome coronavirus 2.