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Prognostic factors associated with mortality risk and disease progression in 639 critically ill patients with COVID-19 in Europe: Initial report of the international RISC-19-ICU prospective observational cohort

2020; Elsevier BV; Volume: 25; Linguagem: Inglês

10.1016/j.eclinm.2020.100449

2589-5370

Pedro David Wendel‐Garcia, Thierry Fumeaux, Philippe Guerci, Dorothea M. Heuberger, Jonathan Montomoli, Ferran Roche‐Campo, Reto Andreas Schuepbach, Matthias P. Hilty, Mario Alfaro Farias, Antoni Margarit, Gerardo Vizmanos-Lamotte, Thomas Tschoellitsch, Jens Meier, Francesco Cardona, Josef Škola, Lenka Horáková, Hernán Aguirre-Bermeo, Janina Apolo, Emmanuel Novy, Marie-Reine Losser, Geoffrey Jurkolow, Gauthier Delahaye, Sascha David, Tobias Welte, Tobias Wengenmayer, Dawid L. Staudacher, Theodoros Aslanidis, Barna Babik, Anita Korsós, János Gál, Hermann Csaba, Abele Donati, Andrea Carsetti, F Turrini, Maria Sole Simonini, Roberto Ceriani, Martina Murrone, Emanuele Rezoagli, Giovanni Vitale, Alberto Fogagnolo, Savino Spadaro, Maddalena Alessandra Wu, Chiara Cogliati, Riccardo Colombo, E Catena, Francesca Facondini, Antonella Potalivo, Gianfilippo Gangitano, Tiziana Perin, Maria Grazia Bocci, Massimo Antonelli, Diederik Gommers, Alper Can İnce, Eric Mayor-Vázquez, María Cruz, M. Cruz Martín Delgado, Raquel Rodriguez Garcia, Jorge Gámez Zapata, Begoña Zalba-Etayo, Herminia Lozano-Gómez, Pedro Castro, Adrián Téllez, Adriana Jacas, Guido Muñoz, Rut Andrea, Jose T. Ortiz‐Pérez, Eduard Quintana, Irene Rovira, Enric Reverter, Javier Fernández, Miquel Ferrer, Joan R. Badia, Arantxa Lander Azcona, Jesús Escos Orta, Philipp Bühler, Silvio D. Brugger, Daniel A. Hofmaenner, Simone Unseld, Frank Ruschitzka, Mallory Moret‐Bochatay, Bernd Yuen, Thomas Hillermann, Hatem Ksouri, Govind Sridharan, Anette Ristic, Michael Sepulcri, Miodrag Filipovic, Urs Pietsch, Petra Salomon, Iris Drvaric, Peter Schott, Severin Urech, Adriana Lambert, Lukas Merki, Marcus Laube, Frank Hillgaertner, Marianne Sieber, Alexander Dullenkopf, Lina Petersen, Serge Grazioli, Peter C. Rimensberger, Isabelle Fleisch, Jerôme Lavanchy, Katharina Marquardt, Karim Shaikh, Hermann Redecker, Michael Stephan, Jan Brem, Bjarte Rogdo, André Birkenmaier, Friederike Meyer zu Bentrup, Patricia Fodor, Pascal Locher, Giovanni Camen, Martin Siegemund, Núria Zellweger, Marie‐Madlen Jeitziner, Béatrice Jenni‐Moser, Christian Bürkle, Gian‐Reto Kleger, Marilene Franchitti Laurent, Jean-Christophe Laurent, Tomislav Gaspert, Marija Jović, Michael Studhalter, Christoph Haberthuer, Roger F. Lussman, Daniela Selz, Didier Naon, Romano Mauri, Samuele Ceruti, Julien Marrel, Mirko Brenni, Rolf Ensner, Nadine Gehring, Antje Heise, Tobias Huebner, Thomas A. Neff, Sara Cereghetti, Filippo Boroli, Jérôme Pugin, Nandor Marczin, Joyce Wong,

Sepsis Diagnosis and Treatment

BackgroundCoronavirus disease 2019 (COVID-19) is associated with a high disease burden with 10% of confirmed cases progressing towards critical illness. Nevertheless, the disease course and predictors of mortality in critically ill patients are poorly understood.MethodsFollowing the critical developments in ICUs in regions experiencing early inception of the pandemic, the European-based, international RIsk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry was created to provide near real-time assessment of patients developing critical illness due to COVID-19.FindingsAs of April 22, 2020, 639 critically ill patients with confirmed SARS-CoV-2 infection were included in the RISC-19-ICU registry. Of these, 398 had deceased or been discharged from the ICU. ICU-mortality was 24%, median length of stay 12 (IQR, 5–21) days. ARDS was diagnosed in 74%, with a minimum P/F-ratio of 110 (IQR, 80–148). Prone positioning, ECCO2R, or ECMO were applied in 57%. Off-label therapies were prescribed in 265 (67%) patients, and 89% of all bloodstream infections were observed in this subgroup (n = 66; RR=3·2, 95% CI [1·7–6·0]). While PCT and IL-6 levels remained similar in ICU survivors and non-survivors throughout the ICU stay (p = 0·35, 0·34), CRP, creatinine, troponin, d-dimer, lactate, neutrophil count, P/F-ratio diverged within the first seven days (p<0·01). On a multivariable Cox proportional-hazard regression model at admission, creatinine, d-dimer, lactate, potassium, P/F-ratio, alveolar-arterial gradient, and ischemic heart disease were independently associated with ICU-mortality.InterpretationThe European RISC-19-ICU cohort demonstrates a moderate mortality of 24% in critically ill patients with COVID-19. Despite high ARDS severity, mechanical ventilation incidence was low and associated with more rescue therapies. In contrast to risk factors in hospitalized patients reported in other studies, the main mortality predictors in these critically ill patients were markers of oxygenation deficit, renal and microvascular dysfunction, and coagulatory activation. Elevated risk of bloodstream infections underscores the need to exercise caution with off-label therapies.