TY - JOUR
T1 - Mortality associated with early changes in ARDS severity in COVID–19 patients – Insights from the PRoVENT–COVID study
AU - Schuijt, Michiel T. U.
AU - Martin-Loeches, Ignacio
AU - PRoVENT–COVID
AU - Schultz, Marcus J.
AU - Collaborative Group members
AU - Paulus, Frederique
AU - Serpa Neto, Ary
AU - Study group members AMC, null
AU - Breel, Jennifer
AU - de Klerk, Eline S.
AU - van Amstel, Rombout B. E.
AU - PRoVENT-COVID
AU - PRoVENT-COVID Collaborative Group
AU - Stilma, W.
N1 - Funding Information: The authors would like to state a special gratitude towards all participating centers and all members of the PRoVENT?COVID Collaborative Group. The PRoVENT?COVID Collaborative Group investigators in alphabetic order: J.P. van Akkeren; A.G. Algera; C.K. Algoe; R.B. van Amstel; O.L. Baur; P. van de Berg; A.E. van den Berg; D.C.J.J. Bergmans; D.I. van den Bersselaar; F.A. Bertens; A.J.G.H. Bindels; M.M. de Boer; S. den Boer; L.S. Boers; M. Bogerd; L.D.J. Bos; M. Botta; J.S. Breel; H. de Bruin; S. de Bruin; C.L. Bruna; L.A. Buiteman?Kruizinga; O. Cremer; R.M. Determann; W. Dieperink; D.A. Dongelmans; H.S. Franke; M.S. Galek?Aldridge; M.J. de Graaff; L.A. Hagens; J.J. Haringman; N.F.L.Heijnen; S.Hiel; S.T. van der Heide; P.L.J. van der Heiden; L.L. Hoeijmakers; L. Hol; M. W. Hollmann; M.E. Hoogendoorn; J. Horn; R. van der Horst; E.L.K. Ie; D. Ivanov; N.P. Juffermans; E. Kho; E.S. de Klerk; A.W.M. Koopman; M. Koopmans; S. Kucukcelebi; M.A. Kuiper; D.W. de Lange; N. van Mourik; I. Martin?Loeches; S.G. Nijbroek; M. Onrust; E.A.N. Oostdijk; F. Paulus; C.J. Pennartz; J. Pillay; L. Pisani; I.M. Purmer; T.C.D. Rettig; J.P Roozeman; M.T.U. Schuijt; M.J. Schultz; A. Serpa Neto; M.E. Sleeswijk; M.R. Smit; P.E. Spronk; W. Stilma; A.C. Strang; A. M. Tsonas; P.R Tuinman; C.M.A. Valk; F.L.Veen; A.P.J. Vlaar; L.I. Veldhuis; P. van Velzen; W.H. van der Ven; P. van Vliet; P. van der Voort; H.H. van der Wier; L. van Welie; H.J.F.T. Wesselink; B. van Wijk; T. Winters; W.Y. Wong; A.R.H. van Zanten. Publisher Copyright: © 2021 The Authors
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Purpose: We investigated changes in ARDS severity and associations with outcome in COVID–19 ARDS patients. Methods: We compared outcomes in patients with ARDS classified as ‘mild’, ‘moderate’ or ‘severe’ at calendar day 1, and after reclassification at calendar day 2. The primary endpoint was 28–day mortality. We also identified which ventilatory parameters had an association with presence of severe ARDS at day 2. We repeated the analysis for reclassification at calendar day 4. Results: Of 895 patients, 8.5%, 60.1% and 31.4% had mild, moderate and severe ARDS at day 1. These proportions were 13.5%, 72.6% and 13.9% at day 2. 28–day mortality was 25.3%, 31.3% and 32.0% in patients with mild, moderate and severe ARDS at day 1 (p = 0.537), compared to 28.6%, 29.2% and 44.3% in patients reclassified at day 2 (p = 0.005). No ventilatory parameter had an independent association with presence of severe ARDS at day 2. Findings were not different reclassifying at day 4. Conclusions: In this cohort of COVID–19 patients, ARDS severity and mortality between severity classes changed substantially over the first 4 days of ventilation. These findings are important, as reclassification could help identify target patients that may benefit from alternative approaches.
AB - Purpose: We investigated changes in ARDS severity and associations with outcome in COVID–19 ARDS patients. Methods: We compared outcomes in patients with ARDS classified as ‘mild’, ‘moderate’ or ‘severe’ at calendar day 1, and after reclassification at calendar day 2. The primary endpoint was 28–day mortality. We also identified which ventilatory parameters had an association with presence of severe ARDS at day 2. We repeated the analysis for reclassification at calendar day 4. Results: Of 895 patients, 8.5%, 60.1% and 31.4% had mild, moderate and severe ARDS at day 1. These proportions were 13.5%, 72.6% and 13.9% at day 2. 28–day mortality was 25.3%, 31.3% and 32.0% in patients with mild, moderate and severe ARDS at day 1 (p = 0.537), compared to 28.6%, 29.2% and 44.3% in patients reclassified at day 2 (p = 0.005). No ventilatory parameter had an independent association with presence of severe ARDS at day 2. Findings were not different reclassifying at day 4. Conclusions: In this cohort of COVID–19 patients, ARDS severity and mortality between severity classes changed substantially over the first 4 days of ventilation. These findings are important, as reclassification could help identify target patients that may benefit from alternative approaches.
KW - ARDS
KW - Acute respiratory distress syndrome
KW - COVID–19
KW - Coronavirus disease 2019
KW - Mortality
UR - http://www.scopus.com/inward/record.url?scp=85109728956&partnerID=8YFLogxK
UR - https://pure.hva.nl/ws/files/23725805/Supplementary_material_1.docx
UR - https://pure.hva.nl/ws/files/23725807/Supplementary_material_2.docx
U2 - https://doi.org/10.1016/j.jcrc.2021.06.016
DO - https://doi.org/10.1016/j.jcrc.2021.06.016
M3 - Article
C2 - 34271294
SN - 0883-9441
VL - 65
SP - 237
EP - 245
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -