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

Mohammadreza Salehi; Mohammad-Taghi Beig Mohammadi; Seyed Hamidreza Abtahi; Samrand Fattah Ghazi; Abolfazl Sobati; Rama Bozorgmehr; Seyed Ali Dehghan Manshadi; Saeed Reza Jamali Siahkali; Mostafa Mohammadi; Banafsheh Moradmand Badie; Tahereh Sajadifard; Ensiyeh Rahimi

doi:10.18502/acta.v61i7.14496

Mohammadreza Salehi Department of Infectious Disease, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Mohammad-Taghi Beig Mohammadi Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Seyed Hamidreza Abtahi Department of Pulmonary and Critical Care Medicine, Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Samrand Fattah Ghazi Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Abolfazl Sobati Department of Nursing and Midwifery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Rama Bozorgmehr Department of Internal Medicine, Clinical Research Development Unit, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Seyed Ali Dehghan Manshadi Department of Infectious Disease, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Saeed Reza Jamali Siahkali Department of Infectious Disease, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
Mostafa Mohammadi Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Banafsheh Moradmand Badie Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), Sydney, Australia..
Tahereh Sajadifard Department of Infectious Disease, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Ensiyeh Rahimi Department of Infectious Disease, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/acta.v61i7.14496

Keywords: COVID-19; Mechanical ventilation; Extubation; Mortality risk factors

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.