Infección grave por coronavirus SARS-CoV-2: experiencia en un hospital de tercer nivel con pacientes afectados por COVID-19 durante la pandemia 2020

Rodríguez, Alejandro; Moreno, Gerard; Gómez, Josep; Carbonell, Raquel; Picó-Plana, Ester; Bofill, Clara Benavent; Parrilla, Rafael Sánchez; Trefler, Sandra; Pitarch, E Esteve; Canadell, Laura; Teixido, X.; Claverías, Laura; Bodí, M.

doi:10.1016/j.medin.2020.05.018

Cited by 35 publications

(26 citation statements)

References 16 publications

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“…ICU admission represents 1.4% of all cases diagnosed and 5.1% of COVID-19-related hospital admissions. The percentage of patients admitted to the ICU is far from the 11.3% reported by Rodríguez et al [ 19 ], although close to the 7% published by Yang et al [ 20 ].…”

Section: Discussionmentioning

confidence: 47%

“…In over half our patients (55.6%) NIV was tested and failed; MV was required in 100% of patients. Other authors have reported high levels of failure of NIV: 85.2% in the Tarragona study [ 19 ]. In the Lombardy and Washington series barely 11% and 19% respectively only received NIV, while the number of patients receiving MV after having received NIV is not specified [ 25 ] and Hua et al report 32.5% of patients treated with NIV.…”

Section: Discussionmentioning

confidence: 99%

“…None of the studies published to date attain 100% of patients under MV. However, the Vitoria study exceeds 90% [ 22 ] and both the Lombardy and Tarragona studies are close (88% and 86%, respectively) [ 19 , 25 ]. At the other extreme, just 24% of patients from the Hua et al series and 42% of the Yang et al series received MV [ 20 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

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COVID-19 and Acute Respiratory Distress Syndrome. Impact of corticosteroid treatment and predictors of poor outcome

Vidal-Cortés¹,

Río-Carbajo²,

Olmo³

et al. 2020

Rev Esp Quimioter

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Objectives. To assess the impact of corticosteroids on inflammatory and respiratory parameters of patients with COVID-19 and acute respiratory distress syndrome (ARDS). Methods. Longitudinal, retrospective, observational study conducted in an ICU of a second level hospital. Adult patients with COVID-19 were included. Baseline characteristics, data on SARS-CoV-2 infection, treatment received, evolution of respiratory and inflammatory parameters, and ICU and hospital stay and mortality were analyzed. Results. A total of 27 patients were included, 63% men, median age: 68.4 (51.8, 72.2) years. All patients met ARDS criteria and received MV and corticosteroids. After corticosteroids treatment we observed a reduction in the O2 A-a gradient [day 0: 322 (249, 425); day 3: 169 (129.5, 239.5) p<0.001; day 5: 144 (127.5, 228.0) p<0.001; day 7: 192 (120, 261) p=0.002] and an increase in the pO2/FiO2 ratio on days 3 and 5, but not on day 7 [day 0: 129 (100, 168); day 3: 193 (140, 236) p=0.002; day 5: 183 (141, 255) p=0.004; day 7: 170 (116, 251) p=0.057]. CRP also decreased on days 3 and 5 and increased again on day 7 [day 0: 16 (8.6, 24); day 3: 3.4 (1.7, 10.2) p<0.001; day 5: 4.1 (1.4, 10.2) p<0.001; day 7: 13.5 (6.8, 17.3) p=0.063]. Persistence of moderate ARDS on day 7 was related to a greater risk of poor outcome (OR 6.417 [1.091-37.735], p=0.040). Conclusion. Corticosteroids appears to reduce the inflammation and temporarily improve the oxygenation in COVID-19 and ARDS patients. Persistence of ARDS after 7 days treatment is a predictor of poor outcome.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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COVID-19 and Acute Respiratory Distress Syndrome. Impact of corticosteroid treatment and predictors of poor outcome

Vidal-Cortés¹,

Río-Carbajo²,

Olmo³

et al. 2020

Rev Esp Quimioter

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“…The PaO2/FiO2 ratio on the day of ICU admission was 132(IQR 96-163) and 1,131 (55•9%) patients meet criteria of severe and 198(9•8%) of mild acute distress respiratory syndrome (ADRS) pro le at ICU admission, 1,174 (58.0%) patients required invasive mechanical ventilation (MV), 906 (44.8%) developed shock and 580 (28.7%) meet criteria of acute kidney injury (AKI). The overall ICU length of stay (LOS) was 14 (8-26) days and similar for survivors (14[8-27]) days and non-survivors (14 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]) days (p=0•10).…”

Section: Resultsmentioning

confidence: 99%

“…c SOFA score corresponds to the severity of organ dysfunction, re ecting six organ systems each with a score range of 0 to 4 points (cardiovascular, hepatic, hematologic, respiratory, neurological, renal), with a total score range of 0 to 24, White blood cell, median (IQR), x10 9 8.4(6.1) 9.7 (6.6-13.6) .001…”

Section: Resultsmentioning

confidence: 99%

Deploying Machine Learning to Validate Clinical Phenotypes and Factors Associated with Mortality risk in 2,022 Critically Ill Patients with COVID-19 in Spain

Rodríguez¹,

Alejandro²,

Ruíz-Botella³

et al. 2020

Preprint

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Background: The identification of factors associated with Intensive Care Unit (ICU) mortality and derived clinical phenotypes in COVID-19 patients could help for a more tailored approach to clinical decision-making that improves prognostic outcomes. Methods: Prospective, multicenter, observational study of critically ill patients with confirmed COVID-19 disease and acute respiratory failure admitted from 63 Intensive Care Units(ICU) in Spain. The objective was to analyze patient’s factors associated with mortality risk and utilize a Machine Learning(ML) to derive clinical COVID-19 phenotypes. Patient features including demographics and clinical data at ICU admission were analyzed. Generalized linear models were used to determine ICU morality risk factors. An unsupervised clustering analysis was applied to determine presence of phenotypes. The prognostic models were validated and their performance was measured using accuracy test, sensitivity, specificity and ROC curves. Results: The database included a total of 2,022 patients (mean age 64[IQR5-71] years, 1423(70.4%) male, median APACHE II score (13[IQR10-17]) and SOFA score (5[IQR3-7]) points. The ICU mortality rate was 32.6%. Of the 3 derived phenotypes, the C(severe) phenotype was the most common (857;42.5%) and was characterized by the interplay of older age (>65 years), high severity of illness and a higher likelihood of development shock. The A(mild) phenotype (537;26.7%) included older age (>65 years), fewer abnormal laboratory values and less development of complications and B (moderate) phenotype (623,30.8%) had similar characteristics of A phenotype but were more likely to present shock. Crude ICU mortality was 45.4%, 25.0% and 20.3% for the C, B and A phenotype respectively. The ICU mortality risk factors and model performance differed between whole population and phenotype classifications.Conclusion: The presented ML model identified three clinical phenotypes that significantly correlated with host-response patterns and ICU mortality. Different risk factors across the whole population and clinical phenotypes were observed which may limit the application of a “one-size-fits-all” model in practice. Funding: None

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Global Impact of Coronavirus Disease 2019 Infection Requiring Admission to the ICU

Tan

Song

Deane

et al. 2021

Chest

159

118

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Background The COVID-19 pandemic has placed unprecedented burden on the delivery of intensive care services worldwide. Research question What is the global point estimate of mortality and risk factors for patients admitted to intensive care units (ICUs) with severe COVID-19? Methods In this systematic review and meta-analysis Medline, Embase and the Cochrane library were searched up to 1 August 2020. Pooled prevalence of participant characteristics, clinical features and outcome data were calculated using random effects models. Subgroup analyses were based on geographical distribution, study type, quality assessment, sample size, end date and patient disposition Results Forty-five studies with 16561 patients from 17 countries across four continents were included. Patients with COVID-19 admitted to ICU had a mean age of 62·6 years (95%CI 60.4-64·7). Common comorbidities included hypertension (49·5% (44·9-54·0)) and diabetes (26·6% (22·7-30·8)). Over three-quarters developed Acute Respiratory Distress Syndrome (76·1% (65·7-85·2)). Invasive mechanical ventilation was required in 67.7% (59.1-75.7), vasopressor support in 65·9% (52.4-78.4), renal replacement therapy in 16·9% (12.1-22·2) and extracorporeal membrane oxygenation in 6·4% (4·1-9.1). The duration of ICU and hospital admission was 10·8 days (9·3-18·4) and 19·1 days (16·3-21·9) respectively with in-hospital mortality of 28·1% (23·4-33·0, I 2 96%). No significant subgroup effect was observed. Interpretation Critically ill patients with COVID-19 who are admitted to ICU require substantial organ support and prolonged ICU and hospital level care. The pooled estimate of global mortality for severe COVID-19 is <1/3.

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Infección grave por coronavirus SARS-CoV-2: experiencia en un hospital de tercer nivel con pacientes afectados por COVID-19 durante la pandemia 2020

Cited by 35 publications

References 16 publications

COVID-19 and Acute Respiratory Distress Syndrome. Impact of corticosteroid treatment and predictors of poor outcome

COVID-19 and Acute Respiratory Distress Syndrome. Impact of corticosteroid treatment and predictors of poor outcome

Deploying Machine Learning to Validate Clinical Phenotypes and Factors Associated with Mortality risk in 2,022 Critically Ill Patients with COVID-19 in Spain

Global Impact of Coronavirus Disease 2019 Infection Requiring Admission to the ICU

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