Outcomes and predictors of mortality in patients with severe COVID-19 and COPD admitted to ICU: A multicenter study.
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Fernández-Barat Laia, Motos Ana, Canseco-Ribas Joan, Gabarrús Albert, López-Aladid Ruben, Alvaro-Meca Alejandro, Ceccato Adrián, García Nadia, Ferrer Miquel, Battaglini Denise, Ávarez-Napagao Sergio, García-Gasulla Dario, Ferrer Ricard, de Gonzalo-Calvo David, Lorente José Ángel, Menéndez Rosario, Peñuelas Oscar, Riera Jordi, Rodríguez Alejandro, Amaya Villar Rosario, Añón José M, Balan Mariño Ana, Barberà Carme, Barberán José, Blandino Ortiz Aaron, Boado Maria Victoria, Bofill Neus, Bustamante-Munguira Elena, Caballero Jesús, Cantón-Bulnes María Luisa, Carbajales Pérez Cristina, Carbonell Nieves, Catalán-González Mercedes, Del Carmen de la Torre Maria, Díaz Emili, Estella Ángel, Figueras Albert, de Frutos Raul, Franco Nieves, Galbán Cristóbal, Gallego Elena, García Garmendia José Luis, González Jessica, Gómez José M, Gumucio-Sanguino Víctor D, Huerta Arturo, Jorge García Ruth Noemí, Loza-Vázquez Ana, Marin-Corral Judith, Martin Delgado María Cruz, Martínez de la Gándara Amalia, Martínez Varela Ignacio, Albaiceta Guillermo M, Nieto Maite, Peñasco Yhivian, Pérez-Bastida Leire, Pérez-García Felipe, Pozo-Laderas Juan Carlos, Ricart Pilar, Sagredo Víctor, Sánchez-Miralles Ángel, Sancho Chinesta Susana, Socias Lorenzo, Solé-Violan Jordi, Suarez-Sipmann Fernando, Tamayo Lomas Luis, Trenado José, Úbeda Alejandro, Jorge Valdivia Luis, Vidal Pablo, Bermejo-Martin Jesús, Barbé Ferran, Torres Antoni, CIBERESUCICOVID Project Investigators
Аннотация
STUDY DESIGN AND METHODS: Epidemiological, clinical, and laboratory data were collected in REDCap for 6512 patients hospitalized with COVID-19 across 55 Spanish ICUs. Patients were stratified into three groups: those with COPD, those with other chronic respiratory diseases (CRD), and those without respiratory comorbidities (No CRD). The primary outcome was to determine clinical predictors for 90-day mortality, focusing on the COPD group. A propensity score matching (PSM) method was applied to analyze the effects of respiratory support, biomarkers, and immunomarkers.
RESULTS: Patients with COPD (n = 328) exhibited a 50% mortality rate compared to 33% of those with other chronic respiratory diseases (CRD, n = 547), and those without respiratory comorbidities (No CRD, n = 5124). Among COPD patients, 95% of whom had Acute Respiratory Distress Syndrome (ARDS) due to COVID-19, the use of a high-flow nasal cannula (HFNC) was associated with reduced 90-day mortality (hazard ratio: 0.54 (95% Confidence Interval [0.31-0.95]). At a molecular scale, lower IgG levels but higher viral load and TNF-alpha, Vascular Cell Adhesion Molecule-1 (VCAM-1), and Fas Cell Surface Death Receptor (Fas) were associated with mortality in the COPD group.
CONCLUSIONS: In COPD patients with ARDS due to COVID-19, the use of HFNC was associated with a better prognosis. The dysregulation in biomarkers and immunomarkers in COPD patients and its association with mortality highlight the need for further targeted therapeutic strategies.