Risk Factors of Death in Mechanically Ventilated COVID-19 Patients: A Multi-Center Study From Iran

Abstract

Despite the improvement in COVID-19 therapeutic management the mortality of mechanically ventilated COVID-19 patients remains high. In this study, we determined the risk factors of death in these cases. This cross-sectional study evaluated clinical and paraclinical features of mechanically ventilated COVID-19 patients at the time of hospital admission until death or discharge from hospital between April and September in 2021 in three COVID-19 referral hospitals. The patients were divided into survivors and non-survivors and then the characteristics were compared. One hundred twenty-five patients (60% male, mean age 62±15.18, range 17 to 97 years old) were recruited to the study. 51(40%) survived and 74 (60%) didn’t survive. At the time of hospital admission, the vital signs were not significantly different between the survivors and non-survivors, although diarrhea was not reported in non-survivors, but reported in 9.5% of survivors (P=0.02). The mean age of non-survivors was higher (65.1±14.17 vs 56.9±15.41, P=0.003). The intubation time since the patients were admitted was not significantly different between the two groups (3.38±2.88 days vs 4.16±3.42 days, P=0.34). The mean of serum LDH and D-dimer at the time of ICU admission were significantly higher in the non-survivors (863±449 vs 613±326, P=0.01; 4081±3342 vs 542±634, P=0.009; respectively). However, the mean CRP was not significantly different between the two groups (76±66.4, 54±84.3; P=0.1). Mean APACHE-II score was higher in the non-survivors than the survivors (15 vs 13; P=0.01). Use of remdesivir, interferon beta-1a, and low dose corticosteroids were significantly higher in the survivors group (P=0.009, P=0.001, P=0.000). Success of weaning and ICU discharge among mechanically ventilated COVID-19 patients are probably higher in younger patients with lower D-dimmer and LDH that received remdesivir, interferon beta-1a and low dose corticosteroids, while the intubation time did not seem to play a role on patients' outcome.

Keywords

• COVID-19
• Mechanical ventilation
• Extubation
• Mortality risk factors