Abstract
Background:
COVID-19 is a highly contagious viral illness caused by SARS-CoV-2, which predominantly targets the respiratory system, infecting more than 435 million people and attributed to more than 5 million deaths worldwide. Studies show different clinical phenotypes associated with COVID-19 infection lung compliance changes. There are equivocal reports in the literature that describe the relationship between ARDS severity and COVID-19 mortality in mechanically ventilated patients. This retrospective study aims to determine a relationship between ARDS severity and COVID-19 survival. Our second aim is to analyze if declining lung function (dynamic compliance [Cdyn]) is associated with decreased chance of survival. Understanding the pattern of changes in Cdyn and severity of lung disease could provide diagnostic and therapeutic benefits in managing and treating COVID-19.
Methods:
We retrospectively analyzed electronic medical record data of patients diagnosed with COVID-19 and invasively mechanically ventilated for at least 5 continuous days at University of Texas Medical Branch at Galveston. We calculated the odds ratios for main effects of interests' association with survival. Chi-square tests were performed for categorical variables, and t-tests for continuous variables. Bivariate logistic regression analysis of main effects (age, gender, race/ethnicity, number of comorbid conditions, use of antiviral medications, ARDS severity day 1 and day 5, Cdyn day 1 and day 5, and PaO2/FIO2 (P/F) ratio day 1 and day 5 as predictors influencing survival were performed. Significant variables were included in the final model. There is a 0.05 level of significance. All tests were performed in RStudio.
Results:
220 patients met the inclusion criteria for our study. Among the patients included, 123 (55.91 %) did not survive, and 97 (44.09 %) survived. Age, gender, race, ARDS severity on day 5, Cdyn on day 5, and P/F ratio on day 5 all showed significant association with survival within this population. Older patients showed a lower chance of survival compared to younger patients. Survival was less frequent for males than females. Cdyn and P/F ratio means trended in a positive direction in patients that survived.
Conclusions:
ARDS severity, P/F ratio, and Cdyn should be considered for diagnostic and therapeutic benefits in management of mechanically ventilated COVID-19 patients.
* = p< 0.05, ref = reference
View all access options for this article.Multivariable Logistic Regression Analysis of Contextual Factors Influencing Mortality
Characteristic
Beta
SE
pvalue
OR
CI 95%
AGE
<= 45
ref
ref
ref
ref
ref
46-55
-0.69
0.70
0.322
0.50
0.13 - 1.97
56-65
-1.02
0.60
0.087
0.36
0.11 - 1.16
>= 66
-2.71
0.64
< 0.001*
0.07
0.02 - 0.23
GENDER MALE
-1.16
0.40
0.003*
0.31
0.14 - 0.69
ETHNICITY
Non-Hispanic White
ref
ref
ref
ref
ref
Non-Hispanic Black
1.54
0.58
0.008*
4.65
1.49 - 14.52
Hispanic
-0.49
0.42
0.243
0.61
0.27 - 1.39
Other
1.44
0.93
0.122
4.22
0.68 - 26.24
COMORBIDITIES
0
ref
ref
ref
ref
ref
1
-1.03
0.53
0.052
0.36
0.13 - 1.01
2
0.62
0.55
0.259
1.85
0.64 - 5.39
3
-0.05
0.59
0.930
1.05
0.33 - 3.38
>=4
0.78
0.65
0.229
2.19
0.55 - 7.84
ARDS DAY 1
Mild
ref
ref
ref
ref
ref
Moderate
-0.06
1.06
0.955
0.94
0.12 – 7.56
Severe
0.22
1.30
0.864
0.80
0.09 - 15.87
ARDS DAY 5
Mild
ref
ref
ref
ref
ref
Moderate
3.32
1.23
0.007*
27.55
2.46 - 308.81
Severe
3.24
1.53
0.034*
25.61
1.28 - 513.61
DYNAMIC COMPLIANCE DAY 1
0.01
0.01
0.739
1.00
0.98 - 1.03
DYNAMIC COMPLIANCE DAY 5
0.03
0.02
0.036*
1.03
1.01 - 1.07
PF RATIO DAY 1
0.01
0.005
0.087
1.01
0.99 - 1.02
PF RATIO DAY 5
0.01
0.006
0.003*
1.02
1.01 - 1.03
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