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. 2025 May 22;44(5):101558.
doi: 10.1016/j.accpm.2025.101558. Online ahead of print.

Outcomes and predictors of mortality in patients with severe COVID-19 and COPD admitted to ICU: A multicenter study

Laia Fernández-Barat  1 , Ana Motos  1 , Joan Canseco-Ribas  2 , Albert Gabarrús  3 , Ruben López-Aladid  3 , Alejandro Alvaro-Meca  4 , Adrián Ceccato  2 , Nadia García  5 , Miquel Ferrer  1 , Denise Battaglini  6 , Sergio Ávarez-Napagao  7 , Dario García-Gasulla  7 , Ricard Ferrer  8 , David de Gonzalo-Calvo  9 , José Ángel Lorente  10 , Rosario Menéndez  11 , Oscar Peñuelas  10 , Jordi Riera  8 , Alejandro Rodríguez  12 , Rosario Amaya Villar  13 , José M Añón  14 , Ana Balan Mariño  15 , Carme Barberà  16 , José Barberán  17 , Aaron Blandino Ortiz  18 , Maria Victoria Boado  19 , Neus Bofill  20 , Elena Bustamante-Munguira  21 , Jesús Caballero  22 , María Luisa Cantón-Bulnes  23 , Cristina Carbajales Pérez  24 , Nieves Carbonell  25 , Mercedes Catalán-González  26 , Maria Del Carmen de la Torre  27 , Emili Díaz  28 , Ángel Estella  29 , Albert Figueras  30 , Raul de Frutos  31 , Nieves Franco  32 , Cristóbal Galbán  33 , Elena Gallego  34 , José Luis García Garmendia  35 , Jessica González  9 , José M Gómez  36 , Víctor D Gumucio-Sanguino  37 , Arturo Huerta  38 , Ruth Noemí Jorge García  39 , Ana Loza-Vázquez  40 , Judith Marin-Corral  41 , María Cruz Martin Delgado  42 , Amalia Martínez de la Gándara  43 , Ignacio Martínez Varela  44 , Guillermo M Albaiceta  45 , Maite Nieto  46 , Yhivian Peñasco  47 , Leire Pérez-Bastida  48 , Felipe Pérez-García  49 , Juan Carlos Pozo-Laderas  50 , Pilar Ricart  51 , Víctor Sagredo  52 , Ángel Sánchez-Miralles  53 , Susana Sancho Chinesta  54 , Lorenzo Socias  55 , Jordi Solé-Violan  56 , Fernando Suarez-Sipmann  57 , Luis Tamayo Lomas  58 , José Trenado  59 , Alejandro Úbeda  60 , Luis Jorge Valdivia  61 , Pablo Vidal  62 , Jesús Bermejo-Martin  63 , Ferran Barbé  9 , Antoni Torres  64 ; CIBERESUCICOVID Project Investigators
Affiliations
Free article

Outcomes and predictors of mortality in patients with severe COVID-19 and COPD admitted to ICU: A multicenter study

Laia Fernández-Barat et al. Anaesth Crit Care Pain Med. .
Free article

Abstract

Background: High mortality rates among patients with chronic obstructive pulmonary disease (COPD) admitted to intensive care units (ICUs) during the COVID-19 pandemic highlight the need for tailored clinical management strategies.

Study design and methods: Epidemiological, clinical, and laboratory data were collected in REDCap for 6512 patients hospitalized with COVID-19 across 55 Spanish ICUs. Patients were stratified into three groups: those with COPD, those with other chronic respiratory diseases (CRD), and those without respiratory comorbidities (No CRD). The primary outcome was to determine clinical predictors for 90-day mortality, focusing on the COPD group. A propensity score matching (PSM) method was applied to analyze the effects of respiratory support, biomarkers, and immunomarkers.

Results: Patients with COPD (n = 328) exhibited a 50% mortality rate compared to 33% of those with other chronic respiratory diseases (CRD, n = 547), and those without respiratory comorbidities (No CRD, n = 5124). Among COPD patients, 95% of whom had Acute Respiratory Distress Syndrome (ARDS) due to COVID-19, the use of a high-flow nasal cannula (HFNC) was associated with reduced 90-day mortality (hazard ratio: 0.54 (95% Confidence Interval [0.31-0.95]). At a molecular scale, lower IgG levels but higher viral load and TNF-alpha, Vascular Cell Adhesion Molecule-1 (VCAM-1), and Fas Cell Surface Death Receptor (Fas) were associated with mortality in the COPD group.

Conclusions: In COPD patients with ARDS due to COVID-19, the use of HFNC was associated with a better prognosis. The dysregulation in biomarkers and immunomarkers in COPD patients and its association with mortality highlight the need for further targeted therapeutic strategies.

Keywords: Acute respiratory distress syndrome; Biomarkers; Chronic obstructive pulmonary disease; High flow nasal cannulas; Respiratory support.

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Conflict of interest statement

Declaration of competing interest Fernando Suarez Sipmann received a Research Grant from Air Liquide and received Consultant fees and services Speaker honoraria from Air Liquide and Maquet Critical Care; Jesús Bermejo received consultant fees from Glaxo Smith Klein (GSK) and has a patent planned GSKEP2038314, he also served as advisory board member in the program PROGRAMA PROFARMA, MINISTERIO INDUSTRIA; Jordi Riera served as ECMO consultant for Medtronic and Medical Simulator, received honoraria lecture fees from Gilead (Antifungals) and Werfen (Anticoagulation); José Manuel Gómez received honoraria lecture fees from SEDANA MEDICAL; Nieves Carbonell received honoraria lecture fees from Pfizer; Pablo Vidal received honoraria lecture fees from Pfizer, MSD, AOP Health, Shionogi, Menarini, Gilead and also support for attending meeting from Pfizer, MSD, AOP Health; Ricard Ferrer received consulting fees from Inotrem, Pfizer, Cytosorbent and he received honoraria lecture fees from Shionogi, MSD, Gilead, Menarini and Thermofisher; Antoni Torres received honoraria lecture fees from Pfizer, MSD, BYOVERSIS and PARATEK.

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