Dataset Information

Severity of respiratory failure at admission and in-hospital mortality in patients with COVID-19: a prospective observational multicentre study.

ABSTRACT:

Objectives

COVID-19 causes lung parenchymal and endothelial damage that lead to hypoxic acute respiratory failure (hARF). The influence of hARF severity on patients' outcomes is still poorly understood.

Design

Observational, prospective, multicentre study.

Setting

Three academic hospitals in Milan (Italy) involving three respiratory high dependency units and three general wards.

Participants

Consecutive adult hospitalised patients with a virologically confirmed diagnosis of COVID-19. Patients aged <18 years or unable to provide informed consent were excluded.

Interventions

Anthropometrical, clinical characteristics and blood biomarkers were assessed within the first 24 hours from admission. hARF was graded as follows: severe (partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2) <100 mm Hg); moderate (PaO2/FiO2 101-200 mm Hg); mild (PaO2/FiO2 201-300 mm Hg) and normal (PaO2/FiO2 >300 mm Hg).

Primary and secondary outcome measures

The primary outcome was the assessment of clinical characteristics and in-hospital mortality based on the severity of respiratory failure. Secondary outcomes were intubation rate and application of continuous positive airway pressure during hospital stay.

Results

412 patients were enrolled (280 males, 68%). Median (IQR) age was 66 (55-76) years with a PaO2/FiO2 at admission of 262 (140-343) mm Hg. 50.2% had a cardiovascular disease. Prevalence of mild, moderate and severe hARF was 24.4%, 21.9% and 15.5%, respectively. In-hospital mortality proportionally increased with increasing impairment of gas exchange (p<0.001). The only independent risk factors for mortality were age ≥65 years (HR 3.41; 95% CI 2.00 to 5.78, p<0.0001), PaO2/FiO2 ratio ≤200 mm Hg (HR 3.57; 95% CI 2.20 to 5.77, p<0.0001) and respiratory failure at admission (HR 3.58; 95% CI 1.05 to 12.18, p=0.04).

Conclusions

A moderate-to-severe impairment in PaO2/FiO2 was independently associated with a threefold increase in risk of in-hospital mortality. Severity of respiratory failure is useful to identify patients at higher risk of mortality.

Trial registration number

NCT04307459.

SUBMITTER: Santus P

PROVIDER: S-EPMC7549463 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Severity of respiratory failure at admission and in-hospital mortality in patients with COVID-19: a prospective observational multicentre study.

Santus Pierachille P Radovanovic Dejan D Saderi Laura L Marino Pietro P Cogliati Chiara C De Filippis Giuseppe G Rizzi Maurizio M Franceschi Elisa E Pini Stefano S Giuliani Fabio F Del Medico Marta M Nucera Gabriella G Valenti Vincenzo V Tursi Francesco F Sotgiu Giovanni G

BMJ open 20201010 10

<h4>Objectives</h4>COVID-19 causes lung parenchymal and endothelial damage that lead to hypoxic acute respiratory failure (hARF). The influence of hARF severity on patients' outcomes is still poorly understood.<h4>Design</h4>Observational, prospective, multicentre study.<h4>Setting</h4>Three academic hospitals in Milan (Italy) involving three respiratory high dependency units and three general wards.<h4>Participants</h4>Consecutive adult hospitalised patients with a virologically confirmed diagn ...[more]

PMID: 33040020

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Dataset Information

Severity of respiratory failure at admission and in-hospital mortality in patients with COVID-19: a prospective observational multicentre study.

Objectives

Design

Setting

Participants

Interventions

Primary and secondary outcome measures

Results

Conclusions

Trial registration number

Publications

Severity of respiratory failure at admission and in-hospital mortality in patients with COVID-19: a prospective observational multicentre study.

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