Presence of comorbidities alters management and worsens outcome of patients with acute respiratory distress syndrome: insights from the LUNG SAFE study

Emanuele Rezoagli, Bairbre A McNicholas, Fabiana Madotto, Tài Pham, Giacomo Bellani, John G Laffey, LUNG SAFE Investigators, the ESICM Trials Group, Emanuele Rezoagli, Bairbre A McNicholas, Fabiana Madotto, Tài Pham, Giacomo Bellani, John G Laffey, LUNG SAFE Investigators, the ESICM Trials Group

Abstract

Background: The impact of underlying comorbidities on the clinical presentation, management and outcomes in patients with ARDS is poorly understood and deserves further investigation.

Objectives: We examined these issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study.

Methods: In this secondary analysis of the patient cohort enrolled in the LUNG SAFE study, our primary objective was to determine the frequency, and impact of comorbidities on the management and ICU survival of patients with ARDS. Secondary outcomes relating to comorbidities included their impact on ventilatory management, the development of organ failures, and on end-of-life care.

Results: Of 2813 patients in the study population, 1692 (60%) had 1 or more comorbidities, of whom 631 (22.4%) had chronic respiratory impairment, 290 (10.3%) had congestive heart failure, 286 (10.2%) had chronic renal failure, 112 (4%) had chronic liver failure, 584 (20.8%) had immune incompetence, and 613 (21.8%) had diabetes. Multiple comorbidities were frequently present, with 423 (25%) having 2 and 182 (11%) having at least 3 or more comorbidities. The use of invasive ventilation (1379 versus 998, 82 versus 89%), neuromuscular blockade (301 versus 249, 18 versus 22%), prone positioning (97 versus 104, 6 versus 9%) and ECMO (32 versus 46, 2 versus 4%) were each significantly reduced in patients with comorbidities as compared to patients with no comorbidity (1692 versus 1121, 60 versus 40%). ICU mortality increased from 27% (n = 303) in patients with no comorbidity to 39% (n = 661) in patients with any comorbidity. Congestive heart failure, chronic liver failure and immune incompetence were each independently associated with increased ICU mortality. Chronic liver failure and immune incompetence were independently associated with more decisions to limitation of life supporting measures.

Conclusions: Most patients with ARDS have significant comorbidities, they receive less aggressive care, and have worse outcomes. Enhancing the care of these patients must be a priority for future clinical studies. Trial registration LUNG-SAFE is registered with ClinicalTrials.gov, number NCT02010073.

Keywords: Chronic liver failure; Chronic renal failure; Chronic respiratory impairment; Comorbidities; Congestive heart failure; Diabetes; Immune suppression.

Conflict of interest statement

All authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Selection of patients for study population. Patients with more than one comorbidity will be classified on the basis of each comorbidity that they have
Fig. 2
Fig. 2
A ICU mortality, B hospital mortality and C limitation of life-sustaining measures as a function of patients with comorbidities. Unadjusted odds ratio calculated versus patients with no comorbidities
Fig. 3
Fig. 3
Unadjusted probability of ICU (A) and hospital survival (B) and limitation of life-sustaining measures (C) at 90-day follow-up by increasing number of comorbidities. We used the log-rank test to assess the differences between curves

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Source: PubMed

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