SepsEast Registry indicates high mortality associated with COVID-19 caused acute respiratory failure in Central-Eastern European intensive care units

Abstract

The coronavirus disease (COVID-19) pandemic caused unprecedented research activity all around the world but publications from Central-Eastern European countries remain scarce. Therefore, our aim was to characterise the features of the pandemic in the intensive care units (ICUs) among members of the SepsEast (Central-Eastern European Sepsis Forum) initiative. We conducted a retrospective, international, multicentre study between March 2020 and February 2021. All adult patients admitted to the ICU with pneumonia caused by COVID-19 were enrolled. Data on baseline and treatment characteristics, organ support and mortality were collected. Eleven centres from six countries provided data from 2139 patients. Patient characteristics were: median 68, [IQR 60-75] years of age; males: 67%; body mass index: 30.1 [27.0-34.7]; and 88% comorbidities. Overall mortality was 55%, which increased from 2020 to 2021 (p = 0.004). The major causes of death were respiratory (37%), cardiovascular (26%) and sepsis with multiorgan failure (21%). 1061 patients received invasive mechanical ventilation (mortality: 66%) without extracorporeal membrane oxygenation (n = 54). The rest of the patients received non-invasive ventilation (n = 129), high flow nasal oxygen (n = 317), conventional oxygen therapy (n = 122), as the highest level of ventilatory support, with mortality of 50%, 39% and 22%, respectively. This is the largest COVID-19 dataset from Central-Eastern European ICUs to date. The high mortality observed especially in those receiving invasive mechanical ventilation renders the need of establishing national-international ICU registries and audits in the region that could provide high quality, transparent data, not only during the pandemic, but also on a regular basis.

Figure 1

Hospital mortality in selected subgroups as compared to the overall cohort. Mortality is expressed in percentages and depicted as squares. Corresponding 95% confidence intervals (95% CI) are given in parentheses and shown as error bars. Dashed and dotted vertical lines represent mortality and boundaries of 95% CI in the overall cohort, respectively.

Figure 2

Distribution of survivors and non-survivors, and mortality during the study period. Absolute numbers of surviving (yellow) and non-surviving (grey) patients (right sided Y-axis) based on the inclusion study week (X-axis) are shown. Orange line represents mortality calculated per study week (left sided Y-axis). Arrows depict the limits of 1st and 2nd wave of COVID-19 pandemic.

Figure 3

Major cause of death. Pie plot with overall distribution (A) and time-based evolution during the study (B; X-axis—study inclusion week, Y-axis—absolute number of patients) is presented for the following causes of death: sepsis and multi-organ failure (SEP, blue), cardiovascular failure (CV, orange), cardio-respiratory failure (CRF, grey), respiratory failure (RESP, yellow), neurological cause (NEU, dark blue).

Figure 4

Disease specific treatment modalities. Each treatment modality is displayed as a pie plot for overall distribution and time-based evolution during the study (X-axis—study inclusion week, Y-axis—absolute number of patients). Respiratory support (A): high-flow nasal oxygen (HFNO, light green); non-invasive ventilation (NON-INV, dark green); invasive mechanical ventilation (INV-VENT, light blue); extracorporeal oxygenation (ECMO, dark blue). Anticoagulation and anti-aggregants (B): no anti-thrombotics (NO; grey); prophylactic low-molecular weight heparin (PROF, light orange); prophylactic low-molecular weight heparin + anti-aggregants (PROF + AG, dark orange); therapeutic low-molecular weight heparin (TH, very light blue); therapeutic low-molecular weight heparin + anti-aggregants (TH + AG, light blue); heparin anticoagulation (HEP, dark blue); heparin anticoagulation + anti-aggregants (HEP + AG—very dark blue). Antivirals (C): no antivirals (NO, grey); remdesivir (REM, dark blue); favirapivir (FAVI, red); lopinavir-ritornavir combination (LOP/RIT, yellow) and their potential combinations. Corticosteroids (D): without steroids (NO, grey); standard dose of dexamethasone 6-8 mg/day equivalents (STD, light green); any higher dose (HIGH, dark green).

Figure 5

Factors subjectively associated with unfavourable outcome. Results of the survey among participating centres are presented for each factor as weighted average of the following rating: not important (1), slightly important (2), important (3), fairly important (4), very important (5).