Decreased serial scores of severe organ failure assessments are associated with survival in mechanically ventilated patients; the prospective Maastricht Intensive Care COVID cohort

Julia L M Bels, Sander M J van Kuijk, Chahinda Ghossein-Doha, Fabian H Tijssen, Rob J J van Gassel, Jeanette Tas, MaastrICCht Collaborators, Ronny M Schnabel, Marcel J H Aries, Marcel C G van de Poll, Dennis C J J Bergmans, Steven J R Meex, Walther N K A van Mook, Iwan C C van der Horst, Bas C T van Bussel, Julia L M Bels, Sander M J van Kuijk, Chahinda Ghossein-Doha, Fabian H Tijssen, Rob J J van Gassel, Jeanette Tas, MaastrICCht Collaborators, Ronny M Schnabel, Marcel J H Aries, Marcel C G van de Poll, Dennis C J J Bergmans, Steven J R Meex, Walther N K A van Mook, Iwan C C van der Horst, Bas C T van Bussel

Abstract

Background: The majority of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are admitted to the Intensive Care Unit (ICU) for mechanical ventilation. The role of multi-organ failure during ICU admission as driver for outcome remains to be investigated yet.

Design and setting: Prospective cohort of mechanically ventilated critically ill with SARS-CoV-2 infection.

Participants and methods: 94 participants of the MaastrICCht cohort (21% women) had a median length of stay of 16 days (maximum of 77). After division into survivors (n = 59) and non-survivors (n = 35), we analysed 1555 serial SOFA scores using linear mixed-effects models.

Results: Survivors improved one SOFA score point more per 5 days (95% CI: 4-8) than non-survivors. Adjustment for age, sex, and chronic lung, renal and liver disease, body-mass index, diabetes mellitus, cardiovascular risk factors, and Acute Physiology and Chronic Health Evaluation II score did not change this result. This association was stronger for women than men (P-interaction = 0.043).

Conclusions: The decrease in SOFA score associated with survival suggests multi-organ failure involvement during mechanical ventilation in patients with SARS-CoV-2. Surviving women appeared to improve faster than surviving men. Serial SOFA scores may unravel an unfavourable trajectory and guide decisions in mechanically ventilated patients with SARS-CoV-2.

Keywords: COVID-19; Cohort study; Multi-organ failure; Repeated data; SARS-CoV-2; SOFA score.

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no competing interests.

Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

Figures

Fig. 1
Fig. 1
SOFA scores over time in ICU-survivors and ICU-non-survivors. A lower SOFA score indicates less organ dysfunction.
Fig. 2
Fig. 2
Observed and predicted SOFA scores over time for ICU-survivors and in ICU-non-survivors. A lower SOFA score indicates less organ dysfunction. Note that some jitter has been applied to the raw data to make multiple observations with the same values visible.
Fig. 3
Fig. 3
Development of categories of SOFA scores over weeks in ICU-survivors and in ICU-non-survivors. A lower SOFA score indicates less organ dysfunction.

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