Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units

Background: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. Aims: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. Study design: Retrospective, observational cohort. Methods: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. Results: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO2/FiO2 ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050). Conclusion: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality

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1. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area. JAMA. 2020;323(20):2052-2059. [CrossRef]
2. Sahin Temel KG, Ulger B., Arican H., et al. Characteristics and outcomes of patients infected with SARS-CoV-2 admitted to intensive care units: Erciyes University COVID-19 center experience. Erciyes Med J. 2020.
3. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. [CrossRef]
4. Wu C, Chen X, Cai Y, et al. Risk factors associated With acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-943. [CrossRef]
5. Halacli B, Kaya A, Topeli A. Critically-ill COVID-19 patient. Turk J Med Sci. 2020;50(SI-1):585-591. [CrossRef]
6. Fox SE, Akmatbekov A, Harbert JL, et al. Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans. Lancet Respir Med. 2020;8(7):681-686. [CrossRef]
7. Gündoğan KTŞ, Baran Ketencioğlu B, Rabah B, Tutar N, Sungur M. Acute Kidney Injury in SARS-CoV-2 infected critically ill patients. Turk J Nephrol 2020;3:185-189. 8. Tutar N, Baran Ketencioglu B, Temel Ş, et al. Images in Vascular Medicine: peripheral artery thrombosis in critically ill patients with COVID-19. Vasc Med (London, England). 2020. PubMed: [CrossRef].
9. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York city: prospective cohort study. BMJ (Clin Res Ed). 2020;369:m1966. [CrossRef]
10. Grasselli G, Greco M, Zanella A, et al. Risk factors associated with mortality among patients With COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020;180(10):1345-1355. [CrossRef]
11. Karagiannidis C, Mostert C, Hentschker C, et al. Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study. Lancet Respir Med. 2020;8(9):853-862. [CrossRef]
12. Xie J, Wu W, Li S, et al. Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study. Intensive Care Med. 2020;46(10):1863-1872. [CrossRef]
13. Xu J, Yang X, Yang L, et al. Clinical course and predictors of 60-day mortality in 239 critically ill patients with COVID-19: a multicenter retrospective study from Wuhan, China. Crit Care. 2020;24(1):394. [CrossRef]
14. Auld SC, Caridi-Scheible M, Blum JM, et al. ICU and ventilator mortality among critically ill adults with coronavirus disease 2019. Crit Care Med. 2020;48(9):e799- e804. [CrossRef]
15. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. [CrossRef]
16. Ñamendys-Silva SA, Alvarado-Ávila PE, Domínguez-Cherit G, et al. Outcomes of patients with COVID-19 in the intensive care unit in Mexico: a multicenter observational study. Heart Lung. 2021;50(1):28-32. [CrossRef]
17. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2020:1-14. 18. Zettersten E, Engerström L, Bell M, et al. Long-term outcome after intensive care for COVID-19: differences between men and women-a nationwide cohort study. Crit Care. 2021;25(1):86. [CrossRef]
19. Turkish Ministiry of health, Covid-19 guideline. (available at: https://www.ekmud.or g.tr/files/uploads/files/Saglik-Bakanligi-COVID-19-rehberi-23032020.pdf); 2020:28- 34.
20. World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance. January 28, 2020. https://www.who.int/docs/default-source/coronaviruse/clinicalmanagement-of-novel-cov.pdf.
21. Simpson S, Kay FU, Abbara S, et al. Radiological society of North America expert consensus statement on reporting chest CT findings related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA - secondary publication. J Thorac Imaging. 2020;35(4):219-227. [CrossRef]
22. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179-c184. [CrossRef]
23. Nachtigall I, Lenga P, Jóźwiak K, et al. Clinical course and factors associated with outcomes among 1904 patients hospitalized with COVID-19 in Germany: an observational study. Clin Microbiol Infect. 2020;26(12):1663-1669. [CrossRef]
24. Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York city: a prospective cohort study. Lancet. 2020;395(10239):1763-1770. [CrossRef]
25. Richards-Belle A, Orzechowska I, Gould DW, et al. COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland. Intensive Care Med. 2020;46(11):2035-2047. [CrossRef]
26. Azoulay E, de Waele J, Ferrer R, et al. International variation in the management of severe COVID-19 patients. Crit Care. 2020;24(1):486. [CrossRef]
27. Salluh JIF, Lisboa T, Bozza FA. Challenges for the care delivery for critically ill COVID-19 patients in developing countries: the Brazilian perspective. Crit Care. 2020;24(1):593. [CrossRef]
28. Litton E, Bucci T, Chavan S, et al. Surge capacity of intensive care units in case of acute increase in demand caused by COVID-19 in Australia. Med J Aust. 2020;212(10):463-467. [CrossRef]
29. Kazzaz YM, Alkhalaf H, Alharbi M, et al. Hospital preparedness and management of pediatric population duringCOVID-19 outbreak. Ann Thorac Med. 2020;15(3):107- 117. [CrossRef]
30. Du RH, Liang LR, Yang CQ, et al. Predictors of mortality for patients with COVID19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020;55(5);2000524. [CrossRef]
31. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481. [CrossRef]
32. Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected With SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA. 2020;323(16):1574-1581. [CrossRef]
33. Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013;369(18):1726-1734. [CrossRef]
34. Nichol AD, Egi M, Pettila V, et al. Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Crit Care. 2010;14(1):R25. [CrossRef]
35. van Mourik N, Geerts BF, Binnekade JM, et al. A higher fluid balance in the days After septic shock reversal is associated with increased mortality: an observational cohort study. Crit Care Explor. 2020;2(10):e0219. [CrossRef]
36. de Oliveira FS, Freitas FG, Ferreira EM, et al. Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock. J Crit Care. 2015;30(1):97-101. [CrossRef]
37. Douglas IS, Alapat PM, Corl KA, et al. Fluid response evaluation in sepsis hypotension and shock: a randomized clinical trial. Chest. 2020;158(4):1431-1445. [CrossRef]
38. Wang YM, Zheng YJ, Chen Y, et al. Effects of fluid balance on prognosis of acute respiratory distress syndrome patients secondary to sepsis. World J Emerg Med. 2020;11(4):216-222. [CrossRef]
39. Abdel-Rahman O. ECOG performance score 0 versus 1: impact on efficacy and safety of first-line 5-FU-based chemotherapy among patients with metastatic colorectal cancer included in five randomized trials. Int J Colorectal Dis. 2019;34(12):2143-2150. [CrossRef]
40. Flaatten H, De Lange DW, Morandi A, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥80 years). Intensive Care Med. 2017;43(12):1820-1828. [CrossRef]
41. Gupta S, Hayek SS, Wang W, et al. Factors associated with death in critically ill patients with coronavirus disease 2019 in the US. JAMA Intern Med. 2020;180(11):1436-1447. [CrossRef]
42. Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802-810. [CrossRef]
43. RECOVERY Collaborative Group, Horby P, Mafham M, et al. Effect of hydroxychloroquine in hospitalized patients with COVID-19. N Engl J Med. 2020;383(21):2030-2040. [CrossRef]