Mortality and Pulmonary Embolism in Acute Respiratory Distress Syndrome From COVID-19 vs. Non-COVID-19

Frontiers in Medicine

article

Demetrios J. Kutsogiannis¹  Abdulrahman Alharthy²  Abdullah Balhamar²  Fahad Faqihi²  John Papanikolaou²  Saleh A. Alqahtani³  Ziad A. Memish⁴  Peter G. Brindley¹  Laurent Brochard⁵  Dimitrios Karakitsos² 

[1] Department of Critical Care Medicine, Faculty of Medicine and Dentistry, The University of Alberta;Critical Care Department;Department of Medicine, The Johns Hopkins University Hospital;Research and Innovation Center;Department of Critical Care, Keenan Research Center and Li Ka Shing Institute, St. Michael's Hospital;Interdepartmental Division of Critical Care Medicine, Institute of Medical Science, University of Toronto;Institute of Medical Science, University of Toronto;Department of Internal Medicine, University of South Carolina, School of Medicine;Critical Care Department, Keck School of Medicine, University of Southern California

关键词: acute respiratory distress syndrome;    pulmonary embolism;    recruitment inflation ratio;    ventilatory ratio;    COVID-19;    respiratory mechanics;    interleukin-6 (IL-6);   

DOI  :  10.3389/fmed.2022.800241

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Purpose There may be a difference in respiratory mechanics, inflammatory markers, and pulmonary emboli in COVID-19 associated ARDS vs. ARDS from other etiologies. Our purpose was to determine differences in respiratory mechanics, inflammatory markers, and incidence of pulmonary embolism in patients with and without COVID-19 associated ARDS admitted in the same period and treated with a similar ventilation strategy. Methods A cohort study of COVID-19 associated ARDS and non COVID-19 patients in a Saudi Arabian center between June 1 and 15, 2020. We measured respiratory mechanics (ventilatory ratio (VR), recruitability index (RI), markers of inflammation, and computed tomography pulmonary angiograms. Results Forty-two patients with COVID-19 and 43 non-COVID patients with ARDS comprised the cohort. The incidence of “recruitable” patients using the recruitment/inflation ratio was slightly lower in COVID-19 patients (62 vs. 86%; p = 0.01). Fifteen COVID-19 ARDS patients (35.7%) developed a pulmonary embolism as compared to 4 (9.3%) in other ARDS patients ( p = 0.003). In COVID-19 patients, a D-Dimer ≥ 5.0 mcg/ml had a 73% (95% CI 45–92%) sensitivity and 89% (95% CI 71–98%) specificity for predicting pulmonary embolism. Crude 60-day mortality was higher in COVID-19 patients (35 vs. 15%; p = 0.039) but three multivariate analysis showed that independent predictors of 60-day mortality included the ventilatory ratio (OR 3.67, 95% CI 1.61–8.35), PaO2/FIO2 ratio (OR 0.93; 95% CI 0.87–0.99), IL-6 (OR 1.02, 95% CI 1.00–1.03), and D-dimer (OR 7.26, 95% CI 1.11–47.30) but not COVID-19 infection. Conclusion COVID-19 patients were slightly less recruitable and had a higher incidence of pulmonary embolism than those with ARDS from other etiologies. A high D-dimer was predictive of pulmonary embolism in COVID-19 patients. COVID-19 infection was not an independent predictor of 60-day mortality in the presence of ARDS.

【 授权许可】

CC BY