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2020 ; 180
(10
): 1345-1355
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English Wikipedia
Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive
Care Units in Lombardy, Italy
#MMPMID32667669
Grasselli G
; Greco M
; Zanella A
; Albano G
; Antonelli M
; Bellani G
; Bonanomi E
; Cabrini L
; Carlesso E
; Castelli G
; Cattaneo S
; Cereda D
; Colombo S
; Coluccello A
; Crescini G
; Forastieri Molinari A
; Foti G
; Fumagalli R
; Iotti GA
; Langer T
; Latronico N
; Lorini FL
; Mojoli F
; Natalini G
; Pessina CM
; Ranieri VM
; Rech R
; Scudeller L
; Rosano A
; Storti E
; Thompson BT
; Tirani M
; Villani PG
; Pesenti A
; Cecconi M
JAMA Intern Med
2020[Oct]; 180
(10
): 1345-1355
PMID32667669
show ga
IMPORTANCE: Many patients with coronavirus disease 2019 (COVID-19) are critically
ill and require care in the intensive care unit (ICU). OBJECTIVE: To evaluate the
independent risk factors associated with mortality of patients with COVID-19
requiring treatment in ICUs in the Lombardy region of Italy. DESIGN, SETTING, AND
PARTICIPANTS: This retrospective, observational cohort study included 3988
consecutive critically ill patients with laboratory-confirmed COVID-19 referred
for ICU admission to the coordinating center (Fondazione IRCCS [Istituto di
Ricovero e Cura a Carattere Scientifico] Ca' Granda Ospedale Maggiore
Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network from February 20
to April 22, 2020. Infection with severe acute respiratory syndrome coronavirus 2
was confirmed by real-time reverse transcriptase-polymerase chain reaction assay
of nasopharyngeal swabs. Follow-up was completed on May 30, 2020. EXPOSURES:
Baseline characteristics, comorbidities, long-term medications, and ventilatory
support at ICU admission. MAIN OUTCOMES AND MEASURES: Time to death in days from
ICU admission to hospital discharge. The independent risk factors associated with
mortality were evaluated with a multivariable Cox proportional hazards
regression. RESULTS: Of the 3988 patients included in this cohort study, the
median age was 63 (interquartile range [IQR] 56-69) years; 3188 (79.9%; 95% CI,
78.7%-81.1%) were men, and 1998 of 3300 (60.5%; 95% CI, 58.9%-62.2%) had at least
1 comorbidity. At ICU admission, 2929 patients (87.3%; 95% CI, 86.1%-88.4%)
required invasive mechanical ventilation (IMV). The median follow-up was 44 (95%
CI, 40-47; IQR, 11-69; range,?0-100) days; median time from symptoms onset to ICU
admission was 10 (95% CI, 9-10; IQR, 6-14) days; median length of ICU stay was 12
(95% CI, 12-13; IQR, 6-21) days; and median length of IMV was 10 (95% CI, 10-11;
IQR, 6-17) days. Cumulative observation time was 164?305 patient-days. Hospital
and ICU mortality rates were 12 (95% CI, 11-12) and 27 (95% CI, 26-29) per 1000
patients-days, respectively. In the subgroup of the first 1715 patients, as of
May 30, 2020, 865 (50.4%) had been discharged from the ICU, 836 (48.7%) had died
in the ICU, and 14 (0.8%) were still in the ICU; overall, 915 patients (53.4%)
died in the hospital. Independent risk factors associated with mortality included
older age (hazard ratio [HR], 1.75; 95% CI, 1.60-1.92), male sex (HR, 1.57; 95%
CI, 1.31-1.88), high fraction of inspired oxygen (Fio2) (HR, 1.14; 95% CI,
1.10-1.19), high positive end-expiratory pressure (HR, 1.04; 95% CI, 1.01-1.06)
or low Pao2:Fio2 ratio (HR, 0.80; 95% CI, 0.74-0.87) on ICU admission, and
history of chronic obstructive pulmonary disease (HR, 1.68; 95% CI, 1.28-2.19),
hypercholesterolemia (HR, 1.25; 95% CI, 1.02-1.52), and type 2 diabetes (HR,
1.18; 95% CI, 1.01-1.39). No medication was independently associated with
mortality (angiotensin-converting enzyme inhibitors HR, 1.17; 95% CI, 0.97-1.42;
angiotensin receptor blockers HR, 1.05; 95% CI, 0.85-1.29). CONCLUSIONS AND
RELEVANCE: In this retrospective cohort study of critically ill patients admitted
to ICUs in Lombardy, Italy, with laboratory-confirmed COVID-19, most patients
required IMV. The mortality rate and absolute mortality were high.
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