Long-term survival of mechanically ventilated patients with severe COVID-19: an observational cohort study

Oscar Peñuelas, Laura Del Campo-Albendea, Amanda Lesmes González de Aledo, José Manuel Añón, Carmen Rodríguez-Solís, Jordi Mancebo, Paula Vera, Daniel Ballesteros, Jorge Jiménez, Emilio Maseda, Juan Carlos Figueira, Nieves Franco, Ángela Algaba, Juan Pablo Avilés, Ricardo Díaz, Beatriz Abad, Alfonso Canabal, Ana Abella, Federico Gordo, Javier García, Jessica García Suarez, Jamil Cedeño, Basilia Martínez-Palacios, Eva Manteiga, Óscar Martínez, Rafael Blancas, Tommaso Bardi, David Pestaña, José Ángel Lorente, Alfonso Muriel, Andrés Esteban, Fernando Frutos-Vivar, Oscar Peñuelas, Laura Del Campo-Albendea, Amanda Lesmes González de Aledo, José Manuel Añón, Carmen Rodríguez-Solís, Jordi Mancebo, Paula Vera, Daniel Ballesteros, Jorge Jiménez, Emilio Maseda, Juan Carlos Figueira, Nieves Franco, Ángela Algaba, Juan Pablo Avilés, Ricardo Díaz, Beatriz Abad, Alfonso Canabal, Ana Abella, Federico Gordo, Javier García, Jessica García Suarez, Jamil Cedeño, Basilia Martínez-Palacios, Eva Manteiga, Óscar Martínez, Rafael Blancas, Tommaso Bardi, David Pestaña, José Ángel Lorente, Alfonso Muriel, Andrés Esteban, Fernando Frutos-Vivar

Abstract

Background: Information is lacking regarding long-term survival and predictive factors for mortality in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) and undergoing invasive mechanical ventilation. We aimed to estimate 180-day mortality of patients with COVID-19 requiring invasive ventilation, and to develop a predictive model for long-term mortality.

Methods: Retrospective, multicentre, national cohort study between March 8 and April 30, 2020 in 16 intensive care units (ICU) in Spain. Participants were consecutive adults who received invasive mechanical ventilation for COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected in positive testing of a nasopharyngeal sample and confirmed by real time reverse-transcriptase polymerase chain reaction (rt-PCR). The primary outcomes was 180-day survival after hospital admission. Secondary outcomes were length of ICU and hospital stay, and ICU and in-hospital mortality. A predictive model was developed to estimate the probability of 180-day mortality.

Results: 868 patients were included (median age, 64 years [interquartile range [IQR], 56-71 years]; 72% male). Severity at ICU admission, estimated by SAPS3, was 56 points [IQR 50-63]. Prior to intubation, 26% received some type of noninvasive respiratory support. The unadjusted overall 180-day survival rates was 59% (95% CI 56-62%). The predictive factors measured during ICU stay, and associated with 180-day mortality were: age [Odds Ratio [OR] per 1-year increase 1.051, 95% CI 1.033-1.068)), SAPS3 (OR per 1-point increase 1.027, 95% CI 1.011-1.044), diabetes (OR 1.546, 95% CI 1.085-2.204), neutrophils to lymphocytes ratio (OR per 1-unit increase 1.008, 95% CI 1.001-1.016), failed attempt of noninvasive positive pressure ventilation prior to orotracheal intubation (OR 1.878 (95% CI 1.124-3.140), use of selective digestive decontamination strategy during ICU stay (OR 0.590 (95% CI 0.358-0.972) and administration of low dosage of corticosteroids (methylprednisolone 1 mg/kg) (OR 2.042 (95% CI 1.205-3.460).

Conclusion: The long-term survival of mechanically ventilated patients with severe COVID-19 reaches more than 50% and may help to provide individualized risk stratification and potential treatments.

Trial registration: ClinicalTrials.gov Identifier: NCT04379258. Registered 10 April 2020 (retrospectively registered).

Keywords: ARDS; COVID-19; Coronavirus disease 2019; Intensive care unit; Invasive mechanical ventilation; Mortality; Noninvasive ventilation; Pneumonia; SARS-CoV-2.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curves. Overall survival at 180 days. Grey lines represent the 95% confidence interval
Fig. 2
Fig. 2
Multivariable-adjusted risk model for death at 180 days and forest plot

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