tetano
Editor, Senior Moderator
J Crit Care
. 2020 Nov 17;62:38-45.
doi: 10.1016/j.jcrc.2020.11.006. Online ahead of print.
Decreased serial scores of severe organ failure assessments are associated with survival in mechanically ventilated patients; the prospective Maastricht Intensive Care COVID cohort
Julia L M Bels[SUP] 1 [/SUP], Sander M J van Kuijk[SUP] 2 [/SUP], Chahinda Ghossein-Doha[SUP] 3 [/SUP], Fabian H Tijssen[SUP] 4 [/SUP], Rob J J van Gassel[SUP] 5 [/SUP], Jeanette Tas[SUP] 6 [/SUP], MaastrICCht Collaborators[SUP] 7 [/SUP], Ronny M Schnabel[SUP] 8 [/SUP], Marcel J H Aries[SUP] 9 [/SUP], Marcel C G van de Poll[SUP] 10 [/SUP], Dennis C J J Bergmans[SUP] 11 [/SUP], Steven J R Meex[SUP] 12 [/SUP], Walther N K A van Mook[SUP] 13 [/SUP], Iwan C C van der Horst[SUP] 14 [/SUP], Bas C T van Bussel[SUP] 15 [/SUP]
Affiliations
Abstract
Background: The majority of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are admitted to the Intensive Care Unit (ICU) for mechanical ventilation. The role of multi-organ failure during ICU admission as driver for outcome remains to be investigated yet.
Design and setting: Prospective cohort of mechanically ventilated critically ill with SARS-CoV-2 infection.
Participants and methods: 94 participants of the MaastrICCht cohort (21% women) had a median length of stay of 16 days (maximum of 77). After division into survivors (n = 59) and non-survivors (n = 35), we analysed 1555 serial SOFA scores using linear mixed-effects models.
Results: Survivors improved one SOFA score point more per 5 days (95% CI: 4-8) than non-survivors. Adjustment for age, sex, and chronic lung, renal and liver disease, body-mass index, diabetes mellitus, cardiovascular risk factors, and Acute Physiology and Chronic Health Evaluation II score did not change this result. This association was stronger for women than men (P-interaction = 0.043).
Conclusions: The decrease in SOFA score associated with survival suggests multi-organ failure involvement during mechanical ventilation in patients with SARS-CoV-2. Surviving women appeared to improve faster than surviving men. Serial SOFA scores may unravel an unfavourable trajectory and guide decisions in mechanically ventilated patients with SARS-CoV-2.
Keywords: COVID-19; Cohort study; Multi-organ failure; Repeated data; SARS-CoV-2; SOFA score.
. 2020 Nov 17;62:38-45.
doi: 10.1016/j.jcrc.2020.11.006. Online ahead of print.
Decreased serial scores of severe organ failure assessments are associated with survival in mechanically ventilated patients; the prospective Maastricht Intensive Care COVID cohort
Julia L M Bels[SUP] 1 [/SUP], Sander M J van Kuijk[SUP] 2 [/SUP], Chahinda Ghossein-Doha[SUP] 3 [/SUP], Fabian H Tijssen[SUP] 4 [/SUP], Rob J J van Gassel[SUP] 5 [/SUP], Jeanette Tas[SUP] 6 [/SUP], MaastrICCht Collaborators[SUP] 7 [/SUP], Ronny M Schnabel[SUP] 8 [/SUP], Marcel J H Aries[SUP] 9 [/SUP], Marcel C G van de Poll[SUP] 10 [/SUP], Dennis C J J Bergmans[SUP] 11 [/SUP], Steven J R Meex[SUP] 12 [/SUP], Walther N K A van Mook[SUP] 13 [/SUP], Iwan C C van der Horst[SUP] 14 [/SUP], Bas C T van Bussel[SUP] 15 [/SUP]
Affiliations
- PMID: 33246196
- PMCID: PMC7669472
- DOI: 10.1016/j.jcrc.2020.11.006
Abstract
Background: The majority of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are admitted to the Intensive Care Unit (ICU) for mechanical ventilation. The role of multi-organ failure during ICU admission as driver for outcome remains to be investigated yet.
Design and setting: Prospective cohort of mechanically ventilated critically ill with SARS-CoV-2 infection.
Participants and methods: 94 participants of the MaastrICCht cohort (21% women) had a median length of stay of 16 days (maximum of 77). After division into survivors (n = 59) and non-survivors (n = 35), we analysed 1555 serial SOFA scores using linear mixed-effects models.
Results: Survivors improved one SOFA score point more per 5 days (95% CI: 4-8) than non-survivors. Adjustment for age, sex, and chronic lung, renal and liver disease, body-mass index, diabetes mellitus, cardiovascular risk factors, and Acute Physiology and Chronic Health Evaluation II score did not change this result. This association was stronger for women than men (P-interaction = 0.043).
Conclusions: The decrease in SOFA score associated with survival suggests multi-organ failure involvement during mechanical ventilation in patients with SARS-CoV-2. Surviving women appeared to improve faster than surviving men. Serial SOFA scores may unravel an unfavourable trajectory and guide decisions in mechanically ventilated patients with SARS-CoV-2.
Keywords: COVID-19; Cohort study; Multi-organ failure; Repeated data; SARS-CoV-2; SOFA score.