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. 2021 Mar 8;46(4):179-191.
doi: 10.1016/j.medin.2021.02.013. Online ahead of print.

Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study

[Article in English, Spanish]
Á Estella  1 , J L Garcia Garmendia  2 , C de la Fuente  3 , J F Machado Casas  4 , M E Yuste  5 , R Amaya Villar  6 , M A Estecha  7 , L Yaguez Mateos  8 , M L Cantón Bulnes  9 , A Loza  10 , J Mora  11 , L Fernández Ruiz  12 , B Díez Del Corral Fernández  13 , M Rojas Amezcua  14 , M I Rodriguez Higueras  15 , I Díaz Torres  16 , M Recuerda Núñez  16 , M Zaheri Beryanaki  17 , F Rivera Espinar  18 , D F Matallana Zapata  19 , S G Moreno Cano  13 , B Gimenez Beltrán  13 , N Muñoz  20 , A Sainz de Baranda Piñero  21 , P Bustelo Bueno  21 , E Moreno Barriga  16 , J J Rios Toro  22 , M Pérez Ruiz  13 , C Gómez González  6 , A Breval Flores  20 , A de San José Bermejo Gómez  23 , M A Ruiz Cabello Jimenez  24 , M Guerrero Marín  8 , A Ortega Ordiales  11 , J Tejero-Aranguren  5 , C Rodriguez Mejías  4 , J Gomez de Oña  25 , C de la Hoz  25 , D Ocaña Fernández  26 , S Ibañez Cuadros  16 , J Garnacho Montero  27 ; Work Group of Infectious Disease (GTEI) de la Sociedad Andaluza de Medicina Intensiva y Unidades coronarias SAMIUC
Affiliations

Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study

[Article in English, Spanish]
Á Estella et al. Med Intensiva (Engl Ed). .

Abstract
in English, Spanish

Objective: The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators.

Design: Prospective descriptive multicenter cohort study.

Setting: 26 Intensive care units (ICU) from Andalusian region in Spain.

Patients or participants: Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30.

Interventions: None.

Variables: Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied.

Results: 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission <6.5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor.

Conclusion: Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor.

Objetivo: Identificar los factores de riesgo asociados con la mortalidad a las seis semanas.

Diseño: Estudio prospectivo multicéntrico.

Ámbito: Se incluyeron a 26 pacientes de la Unidad de Cuidados Intensivos (UCI) de Andalucía.

Pacientes o participantes: Pacientes ingresados en UCI por neumonía grave por SARS-CoV-2 del 8 de marzo al 30 de mayo de 2020.

Intervenciones: Ninguna.

Variables de interés principales: Características demográficas, clínicas y escalas de gravedad. Se analizaron tratamientos de soporte, fármacos y la mortalidad.

Resultados: Se incluyeron 495 pacientes, 73 fueron excluidos por incompletos y 422 pacientes se incorporaron en el análisis final. La mediana de edad fue de 63 años, 305 (72,3%) eran hombres. La mortalidad en la UCI fue: 144/422 34%; mortalidad a los 14 días: 81/422 (19,2%); mortalidad a los 28 días: 121/422 (28,7%); mortalidad a las seis semanas 152/422 36,5%.

Los factores asociados con la mortalidad a los 42 días fueron la edad, APACHE II, SOFA > 6 y LDH al ingreso > 470 U/L, uso de vasopresores, necesidad de técnicas de reemplazo de la función renal, porcentaje de linfocitos a las 72 horas del ingreso en UCI < 6,5%, y trombocitopenia, mientras que el uso de lopinavir/ritonavir fue identificado como un factor protector.

Conclusiones: La edad, gravedad y fracaso orgánico junto con la necesidad de terapias de soporte fueron identificadas como factores predictores de mortalidad a las seis semanas.

La administración de corticoesteroides a dosis altas no mostró beneficios en la mortalidad, al igual que el tratamiento con tocilizumab, lopinavir/ritonavir se identificaron como un factor protector.

Keywords: Corticoides; Corticosteroids; ICU; Lopinavir/ritonavir; SARS-CoV-2; Tocilizumab; UCI.

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Figures

Figure 1
Figure 1
Flowchart of the study participants.
Figure 2
Figure 2
The decision tree based on CRT analysis reached an overall percentage of correct classification of 69.7%. The established risk groups were on a range from 6.1% (APACHE II score ≤ 12 + Age ≤ 62 + PaO2/FiO2 > 160) to 84.6% (APACHE II score >12 + Extrarenal depuration). Patients with APACHE II score > 12 were ever classified with mortality at 6 weeks higher than 49%.
See this image and copyright information in PMC

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