Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units
Kürşat Gündoğan, İsmail Hakkı Akbudak, Pervin Hancı, Burçin Halaçlı, Şahin Temel, Z. Güllü, Kamil İnci, Yelíz Bílír, Firdevs Tuğba Bozkurt, Fatma Yıldırım, Meltem Şimşek, Recep Civan Yüksel, Esma Eren, Neriman Defne Altıntaş, Leyla Talan, Gülseren Elay, Göksel Güven, İskender Kara, Emre Aydın, Seda Güleç Yılmaz, Tuğçe Mengi, Sema Sarı, Türkay Akbaş, Burcu Acar Çinleti, Nazire Ateş Ayhan, Deniz Aral Özbek, Taha Koray Şahin, Aslı Açıkgöz, Ali Ümit Eşbah, Ahmet Fırat, Ferhan Demirer Aydemir, Mehmet Çağatay Gürkök, Avşar Zerman, Ayça Gümüş, Melda Türkoğlu, Müge Aydoğdu, Ramazan Ulu, Jale Bengi Çelik, Canan Balcı, Cenk Kıraklı, Emre Karakoç, Ezgi Özyılmaz, Ebru Ortaç Ersoy, Serpil Öcal, İrem Akın Şen, İbrahim Hakkı Tör, Bilgin Cömert, Begüm Ergan, Kemal Tolga Saraçoğlu, Jülide Ergil
Abstract
BACKGROUND: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. AIMS: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. STUDY DESIGN: Retrospective, observational cohort. METHODS: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. RESULTS: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO2/FiO2 ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050). CONCLUSION: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.