ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Factors Associated with Mortality in Patients with COVID-19 Requiring Mechanical Ventilation: An International Cohort Study from 139 Intensive Care Unit Across 6 Continents
Session Title
A13 - A013 ARDS IN THE TIME OF COVID-19
Abstract
A1059 - Factors Associated with Mortality in Patients with COVID-19 Requiring Mechanical Ventilation: An International Cohort Study from 139 Intensive Care Unit Across 6 Continents
Author Block: G. Li Bassi1, J. Suen1, H. J. Dalton2, N. White3, A. Barnett4, A. Corley1, S. Hinton5, S. Forsyth5, J. G. Laffey6, D. Brodie7, A. Burrell8, E. Fan9, R. Bartlett10, A. Torres11, D. Chiumello12, A. Elhazmi13, C. L. Hodgson14, S. Ichiba15, C. Luna16, S. Murthy17, A. D. Nichol18, P. Yeung Ng19, M. Ogino20, J. Fraser1, COVID-19 Critical Care Consortium; 1Critical care Research Group, The Prince Charles Hospital, Chermside, Australia, 2Institute for Heart and Vascular, Inova Fairfax Medical Center, Falls Church, VA, United States, 3Queensland University of Technology, Brisbane, Australia, 4Queensland Institute of Technology, Brisbane, Australia, 5University of Queensland, Brisbane, Australia, 6Anesthesia, University Hospital Galway, Galway, IRELAND, Ireland, 7Columbia Univ Coll of Phys & Surg, New York, NY, United States, 8Monash University, Melbourne, Australia, 9Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada, 10University of Michigan, Ann Arbor, Australia, 11Hospital Clinic, Barcelona, Spain, 12Ospedale San Paolo, Milan, Italy, 1318.King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, 14DEPM, Monash University, Melbourne, Australia, 15Nippon Medical School Hospital, Tokyo, Japan, 16Hospital de Clínicas, Buenos Aires, Australia, 17University of British Columbia, Vancouver, BC, Canada, 1889 Commercial Rd Level 3 Burnett Bld, Australian New Zealand IC (ANZIC-RC), Melbourne, Australia, 19University of Hong Kong, Hong Kong, China, 20Nemours Alfred I duPont Hospital for Children, Wilmington, DE, United States.
Rationale: Patients with COVID-19 commonly develop severe hypoxemic respiratory failure and require invasive mechanical ventilation (MV). The disease burden and predictors of mortality in this population remain uncertain. Methods: Prospective observational cohort study from 139 intensive care units of the international COVID-19 Critical Care Consortium. Patients enrolled from January 14th through November 31st 2020 were included in the analysis. Patient’s characteristics and clinical data were assessed. Multivariable Cox proportional hazards analysis was conducted to identify indipendent predictors of mortality within 28 days from commencement of MV. Results: 1578 patients on MV were included into the analysis. Mean±SD age was 59 years±13 and patients were predominantly males (66%). 542 Patients (34.4%) died within 28 days from commencement of MV. Non-survivors were slightly older (mean age±SD 62±13 vs. 59±13) and presented more frequently hypertension, chronic cardiac disease and diabetes. Median (IQR) PaO2/FiO2 upon commencement of MV was 96 (68-135) and 111 (81-173) in patients who did not survive vs. survivors, respectively (p=0.04). ECMO (13% vs 25%, p<0.01), inhaled nitric oxide (11% vs 15%, p=0.02) and recruitment manoeauvres (26% vs 31%, p<0.01) were used less frequently in patients who did not survive. Independent risk factors associated with 28-day mortality included age older than 70 years (hazard ratio [HR], 2.83; 95% CI, 1.32-6.07), higher creatinine levels upon ICU admission (HR, 1.20; 95% CI, 1.03-1.40), and lower pH within 24h from commencement of MV (HR, 0.12; 95% CI, 0.02-0.62), while a shorter period (day) from early symptoms to hospitalisation reduced mortality risks (HR, 0.96; 95% CI, 0.93-0.99). Conclusions: Our findings from a large international cohort of critically-ill COVID-19 patients on mechanical ventilation emphasises that elderly patients, not promptly admitted to the hospital, and who present higher creatinine levels and acidosis are at higher risk of mortality. Trial registration: ACTRN12620000421932.
Author Block: G. Li Bassi1, J. Suen1, H. J. Dalton2, N. White3, A. Barnett4, A. Corley1, S. Hinton5, S. Forsyth5, J. G. Laffey6, D. Brodie7, A. Burrell8, E. Fan9, R. Bartlett10, A. Torres11, D. Chiumello12, A. Elhazmi13, C. L. Hodgson14, S. Ichiba15, C. Luna16, S. Murthy17, A. D. Nichol18, P. Yeung Ng19, M. Ogino20, J. Fraser1, COVID-19 Critical Care Consortium; 1Critical care Research Group, The Prince Charles Hospital, Chermside, Australia, 2Institute for Heart and Vascular, Inova Fairfax Medical Center, Falls Church, VA, United States, 3Queensland University of Technology, Brisbane, Australia, 4Queensland Institute of Technology, Brisbane, Australia, 5University of Queensland, Brisbane, Australia, 6Anesthesia, University Hospital Galway, Galway, IRELAND, Ireland, 7Columbia Univ Coll of Phys & Surg, New York, NY, United States, 8Monash University, Melbourne, Australia, 9Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada, 10University of Michigan, Ann Arbor, Australia, 11Hospital Clinic, Barcelona, Spain, 12Ospedale San Paolo, Milan, Italy, 1318.King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, 14DEPM, Monash University, Melbourne, Australia, 15Nippon Medical School Hospital, Tokyo, Japan, 16Hospital de Clínicas, Buenos Aires, Australia, 17University of British Columbia, Vancouver, BC, Canada, 1889 Commercial Rd Level 3 Burnett Bld, Australian New Zealand IC (ANZIC-RC), Melbourne, Australia, 19University of Hong Kong, Hong Kong, China, 20Nemours Alfred I duPont Hospital for Children, Wilmington, DE, United States.
Rationale: Patients with COVID-19 commonly develop severe hypoxemic respiratory failure and require invasive mechanical ventilation (MV). The disease burden and predictors of mortality in this population remain uncertain. Methods: Prospective observational cohort study from 139 intensive care units of the international COVID-19 Critical Care Consortium. Patients enrolled from January 14th through November 31st 2020 were included in the analysis. Patient’s characteristics and clinical data were assessed. Multivariable Cox proportional hazards analysis was conducted to identify indipendent predictors of mortality within 28 days from commencement of MV. Results: 1578 patients on MV were included into the analysis. Mean±SD age was 59 years±13 and patients were predominantly males (66%). 542 Patients (34.4%) died within 28 days from commencement of MV. Non-survivors were slightly older (mean age±SD 62±13 vs. 59±13) and presented more frequently hypertension, chronic cardiac disease and diabetes. Median (IQR) PaO2/FiO2 upon commencement of MV was 96 (68-135) and 111 (81-173) in patients who did not survive vs. survivors, respectively (p=0.04). ECMO (13% vs 25%, p<0.01), inhaled nitric oxide (11% vs 15%, p=0.02) and recruitment manoeauvres (26% vs 31%, p<0.01) were used less frequently in patients who did not survive. Independent risk factors associated with 28-day mortality included age older than 70 years (hazard ratio [HR], 2.83; 95% CI, 1.32-6.07), higher creatinine levels upon ICU admission (HR, 1.20; 95% CI, 1.03-1.40), and lower pH within 24h from commencement of MV (HR, 0.12; 95% CI, 0.02-0.62), while a shorter period (day) from early symptoms to hospitalisation reduced mortality risks (HR, 0.96; 95% CI, 0.93-0.99). Conclusions: Our findings from a large international cohort of critically-ill COVID-19 patients on mechanical ventilation emphasises that elderly patients, not promptly admitted to the hospital, and who present higher creatinine levels and acidosis are at higher risk of mortality. Trial registration: ACTRN12620000421932.
