Long-term survival of mechanically ventilated patients with severe COVID-19: an observational cohort study

Peñuelas, Oscar; del Campo-Albendea, Laura; de Aledo, Amanda Lesmes González; Añón, José Manuel; Rodríguez-Solís, Carmen; Mancebo, Jordi; Vera, Paula; Ballesteros, Daniel; Jiménez, Jorge; Maseda, Emilio; Figueira, Juan Carlos; Franco, Nieves; Algaba, Ángela; Avilés, Juan Pablo; Díaz, Ricardo; Abad, Beatriz; Canabal, Alfonso; Abella, Ana; Gordo, Federico; García, Javier; Suarez, Jessica García; Cedeño, Jamil; Martínez-Palacios, Basilia; Manteiga, Eva; Martínez, Óscar; Blancas, Rafael; Bardi, Tommaso; Pestaña, David; Lorente, José Ángel; Muriel, Alfonso; Esteban, Andrés; Frutos-Vivar, Fernando

BACKGROUND: Information is lacking regarding long-term survival and predictive factors for mortality in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) and undergoing invasive mechanical ventilation. We aimed to estimate 180-day mortality of patients with COVID-19 requiring invasive ventilation, and to develop a predictive model for long-term mortality. METHODS: Retrospective, multicentre, national cohort study between March 8 and April 30, 2020 in 16 intensive care units (ICU) in Spain. Participants were consecutive adults who received invasive mechanical ventilation for COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected in positive testing of a nasopharyngeal sample and confirmed by real time reverse-transcriptase polymerase chain reaction (rt-PCR). The primary outcomes was 180-day survival after hospital admission. Secondary outcomes were length of ICU and hospital stay, and ICU and in-hospital mortality. A predictive model was developed to estimate the probability of 180-day mortality. RESULTS: 868 patients were included (median age, 64 years [interquartile range [IQR], 56–71 years]; 72% male). Severity at ICU admission, estimated by SAPS3, was 56 points [IQR 50–63]. Prior to intubation, 26% received some type of noninvasive respiratory support. The unadjusted overall 180-day survival rates was 59% (95% CI 56–62%). The predictive factors measured during ICU stay, and associated with 180-day mortality were: age [Odds Ratio [OR] per 1-year increase 1.051, 95% CI 1.033–1.068)), SAPS3 (OR per 1-point increase 1.027, 95% CI 1.011–1.044), diabetes (OR 1.546, 95% CI 1.085–2.204), neutrophils to lymphocytes ratio (OR per 1-unit increase 1.008, 95% CI 1.001–1.016), failed attempt of noninvasive positive pressure ventilation prior to orotracheal intubation (OR 1.878 (95% CI 1.124–3.140), use of selective digestive decontamination strategy during ICU stay (OR 0.590 (95% CI 0.358–0.972) and administration of low dosage of corticosteroids (methylprednisolone 1 mg/kg) (OR 2.042 (95% CI 1.205–3.460). CONCLUSION: The long-term survival of mechanically ventilated patients with severe COVID-19 reaches more than 50% and may help to provide individualized risk stratification and potential treatments. Trial registration: ClinicalTrials.gov Identifier: NCT04379258. Registered 10 April 2020 (retrospectively registered) SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-021-00929-y.