Risk factors for non-invasive/invasive ventilatory support in patients with COVID-19 pneumonia: A retrospective study within a multidisciplinary approach. (November 2020)

• Record Type: Journal Article
• Authors: Suardi, Lorenzo Roberto; Pallotto, Carlo; Esperti, Sara; Tazzioli, Elisa; Baragli, Filippo; Salomoni, Elena; Botta, Annarita; Covani Frigieri, Francesca; Pazzi, Maddalena; Stera, Caterina; Carlucci, Martina; Papa, Raffaella; Meconi, Tommaso; Pavoni, Vittorio; Blanc, Pierluigi
• Is Part Of: International journal of infectious diseases. Volume 100(2020)
• Page Start: 258
• Page End: 263
• Publication Date: 2020-11
• Subjects: COVID-19 -- Risk factors -- Multidisciplinary -- Non-invasive ventilation -- Invasive ventilation -- Italy; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.09.012
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a wide spectrum of clinical manifestations, including acute respiratory distress syndrome (ARDS). Continuous positive airway pressure (i.e., non-invasive ventilation) and invasive ventilatory support are often required to manage the acute respiratory failure in patients with coronavirus disease 2019 (COVID-19). Temperature >38 °C, lactate dehydrogenase >250 U/l, and d -dimer >1000 ng/mL were found to be independent risk factors associated with the requirement for non-invasive/invasive ventilator support. Early inflammatory screening is warranted in order to stratify the illness severity and provide appropriate treatment. Abstract: Objectives: To investigate risk factors for non-invasive/invasive ventilatory support (NI/I-VS) in patients with coronavirus disease 2019 (COVID-19). Methods: All consecutive patients admitted to the Infectious Diseases Unit and Intensive Care Unit (ICU) of Santa Maria Annunziata Hospital (Florence, Italy), from February 25 to April 25, 2020, with a confirmed COVID-19 diagnosis were enrolled in this retrospective cohort study. NI/I-VS was defined as the need for continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BPAP) (non-invasive ventilation) or mechanical ventilation, not including low-flow systems of oxygen therapy such as the Venturi mask or nasal cannula. Results: Ninety-seven patients were enrolled; 61.9% (60/97) were male and the median patient age was 64 years. The in-hospital mortality was 9.3%. Thirty-five of the 97 patients (36%) required ICU admission and 94.8% (92/97) were prescribed oxygen therapy: 10.8% (10/92) by nasal cannula, 44.5% (41/92) by Venturi mask, 31.5% (29/92) by CPAP, 2.2% (2/92) by BPAP, and 10.8% (10/92) by mechanical ventilation following intubation. On univariate analysis, patients with a body mass index >30, type II diabetes mellitus, and those presenting with dyspnoea, asthenia, SOFA score ≥2 points, PaO2 /FiO2 <300, temperature >38 °C, increased levels of lactate dehydrogenase (LDH), alanine aminotransferase, and C-reactive protein, and a d -dimer >1000 ng/mL at admission more frequently underwent NI/I-VS. Multivariate logistic regression analysis confirmed temperature >38 °C (odds ratio (OR) 21.2, 95% confidential interval (95% CI) 3.5–124.5, p = 0.001), LDH >250 U/l (OR 15.2, 95% CI 1.8–128.8, p = 0.012), and d -dimer >1000 ng/mL (OR 4.5, 95% CI 1.2–17.3, p = 0.027) as significantly associated with the requirement for NI/I-VS. A non-significant trend ( p = 0.051) was described for PaO2 /FiO2 <300. Conclusions: Temperature >38 °C, LDH > 250 U/l, and d -dimer >1000 ng/mL were found to be independent risk factors for NI/I-VS in COVID-19 patients. In order to quickly identify patients likely at risk of developing a critical illness, inflammatory markers should be assessed upon hospital admission.