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Vol. 46. Issue 4.
Pages 179-191 (April 2022)
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Vol. 46. Issue 4.
Pages 179-191 (April 2022)
Original
Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study
Factores predictivos de la mortalidad a las seis semanas en pacientes críticos con SARS-CoV-2: estudio multicéntrico prospectivo
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Á. Estellaa,
Corresponding author
litoestella@hotmail.com

Corresponding author.
, J.L. Garcia Garmendiab, C. de la Fuentec, J.F. Machado Casasd, M.E. Yustee, R. Amaya Villarf, M.A. Estechag, L. Yaguez Mateosh, M.L. Cantón Bulnesi, A. Lozaj, J. Morak, L. Fernández Ruizl, B. Díez del Corral Fernándeza, M. Rojas Amezcuam, M.I. Rodriguez Higuerasn, I. Díaz Torreso, M. Recuerda Núñezo, M. Zaheri Beryanakip, F. Rivera Espinarq, D.F. Matallana Zapatar, S.G. Moreno Canoa, B. Gimenez Beltrána, N. Muñozs, A. Sainz de Baranda Piñerot, P. Bustelo Buenot, E. Moreno Barrigao, J.J. Rios Torou, M. Pérez Ruiza, C. Gómez Gonzálezf, A. Breval Floress, A. de San José Bermejo Gómezv, M.A. Ruiz Cabello Jimenezw, M. Guerrero Marính, A. Ortega Ordialesk, J. Tejero-Arangurene, C. Rodriguez Mejíasd, J. Gomez de Oñax, C. de la Hozx, D. Ocaña Fernándezy, S. Ibañez Cuadroso, J. Garnacho Monteroz, On behalf of the Work Group of Infectious Disease (GTEI) de la Sociedad Andaluza de Medicina Intensiva y Unidades coronarias SAMIUC
a Intensive Care Unit, Hospital Universitario de Jerez, Jerez, Spain
b Intensive Care Unit, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, Spain
c Intensive Care Unit, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
d Intensive Care Unit, Hospital Universitario Virgen de las Nieves de Granada, Granada, Spain
e Intensive Care Unit, Hospital Universitario Clínico San Cecilio de Granada, Granada, Spain
f Intensive Care Unit, Hospital Universitario Virgen del Rocio de Sevilla, Sevilla, Spain
g Intensive Care Unit, Hospital Universitario Virgen de la Victoria de Málaga, Málaga, Spain
h Intensive Care Unit, Hospital Universitario de Jaén, Jaén, Spain
i Intensive Care Unit, Hospital Universitario Virgen Macarena de Sevilla, Sevilla, Spain
j Intensive Care Unit, Hospital Universitario Virgen de Valme, Sevilla, Spain
k Intensive Care Unit, Hospital Universitario Regional de Málaga, Málaga, Spain
l Intensive Care Unit, Hospital San Juan de la Cruz Úbeda, Úbeda, Jaén, Spain
m Intensive Care Unit, Hospital Infanta Margarita de Cabra, Cabra, Spain
n Intensive Care Unit, Hospital Universitario Torrecárdenas Almería, Almería, Spain
o Intensive Care Unit, Hospital Universitario de Puerto Real, Puerto Real, Spain
p Intensive Care Unit, Hospital de Antequera, Antequera, Spain
q Intensive Care Unit, Hospital de Montilla, Montilla, Córdoba, Spain
r Intensive Care Unit, Hospital Infanta Elena de Huelva, Hospital Quirón Huelva, Huelva, Spain
s Intensive Care Unit, Hospital de la Cruz Roja de Córdoba, Córdoba, Spain
t Intensive Care Unit, Hospital HLA Puerta del Sur de Jerez, Jerez, Spain
u Intensive Care Unit, Hospital de Ronda, Ronda, Spain
v Intensive Care Unit, Hospital San Juan de Dios de Córdoba, Córdoba, Spain
w Intensive Care Unit, Hospital de Pozoblanco, Pozoblanco, Córdoba, Spain
x Intensive Care Unit, Hospital de Poniente, Almería, Spain
y Intensive Care Unit, Hospital La Inmaculada Huercal-Overa de Almería, Almería, Spain
z Intensive Care Unit, Hospital Universitario Virgen de la Macarena Sevilla, Sevilla, Spain
Article information
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Statistics
Figures (2)
Tables (4)
Table 1. Baseline characteristics and univariate analysis with 6 weeks mortality.
Table 2. Laboratory findings of all critically ill patients on day 1 and 3 of ICU admission.
Table 3. Relationship between Delta SOFA score 0–72h and mortality.
Table 4. Multivariate Cox regression analysis of variables associated with mortality at 6 weeks with Propensity Score for lopinavir/ritonavir.
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Additional material (1)
Abstract
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 >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h 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.

Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab.

Lopinavir/ritonavir administration is identified as a protective factor.

Keywords:
SARS-CoV-2
ICU
Corticosteroids
Tocilizumab
Lopinavir/ritonavir
Resumen
Objetivo

Identificar los factores de riesgo asociados con la mortalidad a las seis semanas.

Diseño

Estudio prospectivo multicéntrico.

Ámbito

Se incluyeron a 26 pacientes de la Unidad de Cuidados Intensivos (UCI) de Andalucía.

Pacientes o participantes

Pacientes ingresados en UCI por neumonía grave por SARS-CoV-2 del 8 de marzo al 30 de mayo de 2020.

Intervenciones

Ninguna.

Variables de interés principales

Características demográficas, clínicas y escalas de gravedad. Se analizaron tratamientos de soporte, fármacos y la mortalidad.

Resultados

Se incluyeron 495 pacientes, 73 fueron excluidos por incompletos y 422 pacientes se incorporaron en el análisis final. La mediana de edad fue de 63 años, 305 (72,3%) eran hombres. La mortalidad en la UCI fue: 144/422 34%; mortalidad a los 14 días: 81/422 (19,2%); mortalidad a los 28 días: 121/422 (28,7%); mortalidad a las seis semanas 152/422 36,5%.

Los factores asociados con la mortalidad a los 42 días fueron la edad, APACHE II, SOFA > 6 y LDH al ingreso > 470 U/L, uso de vasopresores, necesidad de técnicas de reemplazo de la función renal, porcentaje de linfocitos a las 72 horas del ingreso en UCI < 6,5%, y trombocitopenia, mientras que el uso de lopinavir/ritonavir fue identificado como un factor protector.

Conclusiones

La edad, gravedad y fracaso orgánico junto con la necesidad de terapias de soporte fueron identificadas como factores predictores de mortalidad a las seis semanas.

La administración de corticoesteroides a dosis altas no mostró beneficios en la mortalidad, al igual que el tratamiento con tocilizumab, lopinavir/ritonavir se identificaron como un factor protector.

Palabras clave:
SARS-CoV-2
UCI
Corticoides
Tocilizumab
Lopinavir/ritonavir

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