Mortality associated with early changes in ARDS severity in COVID-19 patients - Insights from the PRoVENT-COVID study

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<p>PURPOSE: We investigated changes in ARDS severity and associations with outcome in COVID-19 ARDS patients.</p><p>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.</p><p>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.</p><p>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.</p>

Reference Schuijt, M. T. U., Martin-Loeches, I., Schultz, M. J., Paulus, F., Neto, A. S., PRoVENT-COVID, PRoVENT-COVID Collaborative Group, & Stilma, W. (2021). Mortality associated with early changes in ARDS severity in COVID-19 patients - Insights from the PRoVENT-COVID study. Journal of Critical Care, 65, 237-245. https://doi.org/10.1016/j.jcrc.2021.06.016
Published by  Urban Vitality 1 October 2021

Publication date

Oct 2021

Author(s)

Michiel T.U. Schuijt
Ignacio Martin-Loeches
Marcus J. Schultz
Frederique Paulus
Ary Serpa Neto
PRoVENT-COVID
PRoVENT-COVID Collaborative Group

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Research database