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Predictors of in-hospital mortality in critically ill patients with COVID-19: a large dual tertiary centre study
OBJECTIVES: The aim of this study was to investigate the relationship of echocardiographic parameters, laboratory findings and clinical characteristics with in-hospital mortality in adult patients with COVID-19 admitted to the intensive care units (ICU) in two large collaborating tertiary UK centres...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716800/ https://www.ncbi.nlm.nih.gov/pubmed/36456009 http://dx.doi.org/10.1136/bmjopen-2021-059358 |
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author | Cirillo, Chiara Nakou, Eleni Georgiopoulos, Georgios Tountas, Christos Victor, Kelly Marvaki, Apostolia Desai, Nishita Fisher, Richard Ryan, Matthew Demir, Ozan M Corcoran, Eleanor O’Gallagher, Kevin Sinclair, Hannah Pericao, Ana Dhariwal, Anender Stylianidis, Vasileios Hua, Alina Nabeebaccus, Adam Abner Pearson, Peter Fonseca, Tiago Osborne, Andrew Toth, Eva Zuckerman, Mark Shah, Ajay M Perera, Divaka Monaghan, Mark Carr-White, Gerald Papachristidis, Alexandros |
author_facet | Cirillo, Chiara Nakou, Eleni Georgiopoulos, Georgios Tountas, Christos Victor, Kelly Marvaki, Apostolia Desai, Nishita Fisher, Richard Ryan, Matthew Demir, Ozan M Corcoran, Eleanor O’Gallagher, Kevin Sinclair, Hannah Pericao, Ana Dhariwal, Anender Stylianidis, Vasileios Hua, Alina Nabeebaccus, Adam Abner Pearson, Peter Fonseca, Tiago Osborne, Andrew Toth, Eva Zuckerman, Mark Shah, Ajay M Perera, Divaka Monaghan, Mark Carr-White, Gerald Papachristidis, Alexandros |
author_sort | Cirillo, Chiara |
collection | PubMed |
description | OBJECTIVES: The aim of this study was to investigate the relationship of echocardiographic parameters, laboratory findings and clinical characteristics with in-hospital mortality in adult patients with COVID-19 admitted to the intensive care units (ICU) in two large collaborating tertiary UK centres. DESIGN: Observational retrospective study. SETTING: The study was conducted in patients admitted to the ICU in two large tertiary centres in London, UK. PARTICIPANTS: Inclusion criteria were: (1) patients admitted to the ICU with a COVID-19 diagnosis over a period of 16 weeks. and (2) underwent a transthoracic echocardiogram on the first day of ICU admission as clinically indicated. No exclusion criteria applied. Three hundred patients were enrolled and completed the follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome measure in this study was in-hospital mortality in patients admitted to the ICU with COVID-19 infection. RESULTS: Older age (HR: 1.027, 95% CI 1.007 to 1.047; p=0.008), left ventricular (LV) ejection fraction<35% (HR: 5.908, 95% CI 2.609 to 13.376; p<0.001), and peak C reactive protein (CRP) (HR: 1.002, 95% CI 1.001 to 1.004, p=0.001) were independently correlated with mortality in a multivariable Cox regression model. Following multiple imputation of variables with more than 5% missing values, random forest analysis was applied to the imputed data. Right ventricular (RV) basal diameter (RVD1), RV mid-cavity diameter (RVD2), tricuspid annular plane systolic excursion, RV systolic pressure, hypertension, RV dysfunction, troponin level on admission, peak CRP, creatinine level on ICU admission, body mass index and age were found to have a high relative importance (> 0.7). CONCLUSIONS: In patients with COVID-19 in the ICU, both severely impaired LV function and impaired RV function may have adverse prognostic implications, but older age and inflammatory markers appear to have a greater impact. A combination of echocardiographic and laboratory investigations as well as demographic and clinical characteristics appears appropriate for risk stratification in patients with COVID-19 who are admitted to the ICU. |
format | Online Article Text |
id | pubmed-9716800 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-97168002022-12-03 Predictors of in-hospital mortality in critically ill patients with COVID-19: a large dual tertiary centre study Cirillo, Chiara Nakou, Eleni Georgiopoulos, Georgios Tountas, Christos Victor, Kelly Marvaki, Apostolia Desai, Nishita Fisher, Richard Ryan, Matthew Demir, Ozan M Corcoran, Eleanor O’Gallagher, Kevin Sinclair, Hannah Pericao, Ana Dhariwal, Anender Stylianidis, Vasileios Hua, Alina Nabeebaccus, Adam Abner Pearson, Peter Fonseca, Tiago Osborne, Andrew Toth, Eva Zuckerman, Mark Shah, Ajay M Perera, Divaka Monaghan, Mark Carr-White, Gerald Papachristidis, Alexandros BMJ Open Infectious Diseases OBJECTIVES: The aim of this study was to investigate the relationship of echocardiographic parameters, laboratory findings and clinical characteristics with in-hospital mortality in adult patients with COVID-19 admitted to the intensive care units (ICU) in two large collaborating tertiary UK centres. DESIGN: Observational retrospective study. SETTING: The study was conducted in patients admitted to the ICU in two large tertiary centres in London, UK. PARTICIPANTS: Inclusion criteria were: (1) patients admitted to the ICU with a COVID-19 diagnosis over a period of 16 weeks. and (2) underwent a transthoracic echocardiogram on the first day of ICU admission as clinically indicated. No exclusion criteria applied. Three hundred patients were enrolled and completed the follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome measure in this study was in-hospital mortality in patients admitted to the ICU with COVID-19 infection. RESULTS: Older age (HR: 1.027, 95% CI 1.007 to 1.047; p=0.008), left ventricular (LV) ejection fraction<35% (HR: 5.908, 95% CI 2.609 to 13.376; p<0.001), and peak C reactive protein (CRP) (HR: 1.002, 95% CI 1.001 to 1.004, p=0.001) were independently correlated with mortality in a multivariable Cox regression model. Following multiple imputation of variables with more than 5% missing values, random forest analysis was applied to the imputed data. Right ventricular (RV) basal diameter (RVD1), RV mid-cavity diameter (RVD2), tricuspid annular plane systolic excursion, RV systolic pressure, hypertension, RV dysfunction, troponin level on admission, peak CRP, creatinine level on ICU admission, body mass index and age were found to have a high relative importance (> 0.7). CONCLUSIONS: In patients with COVID-19 in the ICU, both severely impaired LV function and impaired RV function may have adverse prognostic implications, but older age and inflammatory markers appear to have a greater impact. A combination of echocardiographic and laboratory investigations as well as demographic and clinical characteristics appears appropriate for risk stratification in patients with COVID-19 who are admitted to the ICU. BMJ Publishing Group 2022-12-01 /pmc/articles/PMC9716800/ /pubmed/36456009 http://dx.doi.org/10.1136/bmjopen-2021-059358 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Infectious Diseases Cirillo, Chiara Nakou, Eleni Georgiopoulos, Georgios Tountas, Christos Victor, Kelly Marvaki, Apostolia Desai, Nishita Fisher, Richard Ryan, Matthew Demir, Ozan M Corcoran, Eleanor O’Gallagher, Kevin Sinclair, Hannah Pericao, Ana Dhariwal, Anender Stylianidis, Vasileios Hua, Alina Nabeebaccus, Adam Abner Pearson, Peter Fonseca, Tiago Osborne, Andrew Toth, Eva Zuckerman, Mark Shah, Ajay M Perera, Divaka Monaghan, Mark Carr-White, Gerald Papachristidis, Alexandros Predictors of in-hospital mortality in critically ill patients with COVID-19: a large dual tertiary centre study |
title | Predictors of in-hospital mortality in critically ill patients with COVID-19: a large dual tertiary centre study |
title_full | Predictors of in-hospital mortality in critically ill patients with COVID-19: a large dual tertiary centre study |
title_fullStr | Predictors of in-hospital mortality in critically ill patients with COVID-19: a large dual tertiary centre study |
title_full_unstemmed | Predictors of in-hospital mortality in critically ill patients with COVID-19: a large dual tertiary centre study |
title_short | Predictors of in-hospital mortality in critically ill patients with COVID-19: a large dual tertiary centre study |
title_sort | predictors of in-hospital mortality in critically ill patients with covid-19: a large dual tertiary centre study |
topic | Infectious Diseases |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716800/ https://www.ncbi.nlm.nih.gov/pubmed/36456009 http://dx.doi.org/10.1136/bmjopen-2021-059358 |
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