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Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months

PURPOSE: Clinical characteristics and management of COVID-19 patients have evolved during the pandemic, potentially changing their outcomes. We analyzed the associations of changes in mortality rates with clinical profiles and respiratory support strategies in COVID-19 critically ill patients. METHO...

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Autores principales: Kurtz, Pedro, Bastos, Leonardo S. L., Dantas, Leila F., Zampieri, Fernando G., Soares, Marcio, Hamacher, Silvio, Salluh, Jorge I. F., Bozza, Fernando A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044656/
https://www.ncbi.nlm.nih.gov/pubmed/33852032
http://dx.doi.org/10.1007/s00134-021-06388-0
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author Kurtz, Pedro
Bastos, Leonardo S. L.
Dantas, Leila F.
Zampieri, Fernando G.
Soares, Marcio
Hamacher, Silvio
Salluh, Jorge I. F.
Bozza, Fernando A.
author_facet Kurtz, Pedro
Bastos, Leonardo S. L.
Dantas, Leila F.
Zampieri, Fernando G.
Soares, Marcio
Hamacher, Silvio
Salluh, Jorge I. F.
Bozza, Fernando A.
author_sort Kurtz, Pedro
collection PubMed
description PURPOSE: Clinical characteristics and management of COVID-19 patients have evolved during the pandemic, potentially changing their outcomes. We analyzed the associations of changes in mortality rates with clinical profiles and respiratory support strategies in COVID-19 critically ill patients. METHODS: A multicenter cohort of RT-PCR-confirmed COVID-19 patients admitted at 126 Brazilian intensive care units between February 27(th) and October 28(th), 2020. Assessing temporal changes in deaths, we identified distinct time periods. We evaluated the association of characteristics and respiratory support strategies with 60-day in-hospital mortality using random-effects multivariable Cox regression with inverse probability weighting. RESULTS: Among the 13,301 confirmed-COVID-19 patients, 60-day in-hospital mortality was 13%. Across four time periods identified, younger patients were progressively more common, non-invasive respiratory support was increasingly used, and the 60-day in-hospital mortality decreased in the last two periods. 4188 patients received advanced respiratory support (non-invasive or invasive), from which 42% underwent only invasive mechanical ventilation, 37% only non-invasive respiratory support and 21% failed non-invasive support and were intubated. After adjusting for organ dysfunction scores and premorbid conditions, we found that younger age, absence of frailty and the use of non-invasive respiratory support (NIRS) as first support strategy were independently associated with improved survival (hazard ratio for NIRS first [95% confidence interval], 0.59 [0.54–0.65], p < 0.001). CONCLUSION: Age and mortality rates have declined over the first 8 months of the pandemic. The use of NIRS as the first respiratory support measure was associated with survival, but causal inference is limited by the observational nature of our data. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00134-021-06388-0.
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spelling pubmed-80446562021-04-14 Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months Kurtz, Pedro Bastos, Leonardo S. L. Dantas, Leila F. Zampieri, Fernando G. Soares, Marcio Hamacher, Silvio Salluh, Jorge I. F. Bozza, Fernando A. Intensive Care Med Original PURPOSE: Clinical characteristics and management of COVID-19 patients have evolved during the pandemic, potentially changing their outcomes. We analyzed the associations of changes in mortality rates with clinical profiles and respiratory support strategies in COVID-19 critically ill patients. METHODS: A multicenter cohort of RT-PCR-confirmed COVID-19 patients admitted at 126 Brazilian intensive care units between February 27(th) and October 28(th), 2020. Assessing temporal changes in deaths, we identified distinct time periods. We evaluated the association of characteristics and respiratory support strategies with 60-day in-hospital mortality using random-effects multivariable Cox regression with inverse probability weighting. RESULTS: Among the 13,301 confirmed-COVID-19 patients, 60-day in-hospital mortality was 13%. Across four time periods identified, younger patients were progressively more common, non-invasive respiratory support was increasingly used, and the 60-day in-hospital mortality decreased in the last two periods. 4188 patients received advanced respiratory support (non-invasive or invasive), from which 42% underwent only invasive mechanical ventilation, 37% only non-invasive respiratory support and 21% failed non-invasive support and were intubated. After adjusting for organ dysfunction scores and premorbid conditions, we found that younger age, absence of frailty and the use of non-invasive respiratory support (NIRS) as first support strategy were independently associated with improved survival (hazard ratio for NIRS first [95% confidence interval], 0.59 [0.54–0.65], p < 0.001). CONCLUSION: Age and mortality rates have declined over the first 8 months of the pandemic. The use of NIRS as the first respiratory support measure was associated with survival, but causal inference is limited by the observational nature of our data. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00134-021-06388-0. Springer Berlin Heidelberg 2021-04-14 2021 /pmc/articles/PMC8044656/ /pubmed/33852032 http://dx.doi.org/10.1007/s00134-021-06388-0 Text en © Springer-Verlag GmbH Germany, part of Springer Nature 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original
Kurtz, Pedro
Bastos, Leonardo S. L.
Dantas, Leila F.
Zampieri, Fernando G.
Soares, Marcio
Hamacher, Silvio
Salluh, Jorge I. F.
Bozza, Fernando A.
Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months
title Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months
title_full Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months
title_fullStr Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months
title_full_unstemmed Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months
title_short Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months
title_sort evolving changes in mortality of 13,301 critically ill adult patients with covid-19 over 8 months
topic Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044656/
https://www.ncbi.nlm.nih.gov/pubmed/33852032
http://dx.doi.org/10.1007/s00134-021-06388-0
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