Predictive factors of six-week mortality in critically ill patients with SARS COV 2: a multicenter prospective study

Estella, Ángel; Garmendia, Jose Luís Garcia; de la Fuente, Carmen; Casas, Juan F. Machado; Yuste, Maria Eugenia; Villar, Rosario Amaya; Antonia Estecha, Mª; Mateos, Luis Yaguez; Bulnes, Maria Luisa Cantón; Loza, Ana; Ordoñez, Juan Miguel Mora; Ruiz, Laura Fernández; Fernández, Beatriz Díez del Corral; Amezcua, Maria Rojas; Higueras, Maria Isabel Rodriguez; Torres, Isabel Díaz; Núñez, María Recuerda; Beryanaki, Mehdi Zaheri; Espinar, Francisco Rivera; Zapata, Diego Fernando Matallana; Cano, Sara Guadalupe Moreno; Beltrán, Barbara Gimenez; Muñoz, Noelia; Sainz de Baranda Piñero, Andrés; Bueno, Pedro Bustelo; Barriga, Elvira Moreno; Toro, Juan Jesús Rios; Ruiz, Miriam Perez; González, Carmen Gómez; Flores, Ana Breval; Bermejo Gomez, Alberto de San Jose; Ángeles Ruiz Cabello Jimenez, Mª; Marín, María Guerrero; Ordiales, Ane Ortega; Tejero-Aranguren, Julia; Mejías, Candela Rodriguez; Gomez de Oña, Julia; la Hoz, Celia de; Fernández, Dolores Ocaña; Cuadros, Sonia Ibañez; Montero, Jose Garnacho

Objective: The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. Design: Prospective descriptive multicenter cohort study. Setting: 26 Intensive care units (ICU) from Andalusian region in Spain. Patients or participants: Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. Interventions: None. Variables: Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. Results: 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72,3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19,2%); 28 days mortality: 121/422 (28,7%) ; 6-week Mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission > 470 U/L, Use of vasopressors, extrarenal depuration, %Lymphocytes 72 h post-ICU admission <6,5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor. Conclusion: Age, APACHE II, SOFA > value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks.