Infectious Disease

The outcomes of sufferers with COVID-19 differ relying on the extent of organ assist and age

February 15, 2021

3 min read

Source / information

Source:

Lal A et al. Studies that will change your practice. Presented at: Critical Care Congress of the Society of Critical Care Medicine; Jan. 31-Feb. 12, 2021 (virtual meeting).

Disclosure:
Lal does not report any relevant financial information.

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New data from the international study registry for international viral infections and respiratory diseases confirm the different results of patients with COVID-19 by type and combination of organ support therapy and age.

The results were presented at the Critical Care Congress of the Society of Critical Care Medicine.

Source: Adobe Stock.

Amos Lal, MBBS, MD, Fellow in the Intensive Care Unit in the Pulmonary and Intensive Care Unit at Mayo Clinic in Rochester, Minnesota, and colleagues described hospital patient outcomes on the multicenter international VIRUS registry. The cross-sectional observational study included more than 49,000 patients who were hospitalized in 179 hospitals in 16 countries from February to November 2020.

Lal presented data from 20,608 patients with confirmed SARS-CoV-2 infection (54.3% men). Of these, 3,986 were 18 to 44 years old, 5,300 45 to 60 years, 6,491 60 to 74 years and 4,831 75 years and older. Elderly patients had more comorbid conditions at baseline, including high blood pressure (15.9% in the 18-44 group versus 65.9% in the 75-year-old and older group), diabetes (15.6% versus 32.1%), and chronic kidney disease (3.6% vs. 20.4%) and coronary heart disease (1.2% vs. 22.7%).

Patients were stratified by type of organ support therapy: 15,001 required no assistance, 5,005 required invasive mechanical ventilation, and 602 required vasoactive medication and / or acute renal replacement therapy with or without invasive mechanical ventilation. A further stratification showed that 1,749 patients only required invasive mechanical ventilation, 2,032 both invasive mechanical ventilation and vasoactive drugs, 655 invasive mechanical ventilation, vasoactive drugs and renal replacement therapy, 180 invasive mechanical ventilation and renal replacement therapy, and 389 extracorporeal therapy Membrane oxygenation required according to the data provided.

The primary outcome was hospital mortality based on the type of organ support therapy received. Secondary outcomes included home discharge with or without assistance, and length of stay in the hospital or intensive care unit.

Overall steroid use was 13.7%, and use was high among 45 to 60 year olds (14.9%) and 60 to 74 year olds (15.3%) and among 18 to 44 year olds Year olds (13.1%) and 75 year olds the lowest years and older (10.6%), Lal said.

The researchers observed an increase in length of hospital stay with age, from a median of 5 days in the youngest age group and nearly 9 days in the oldest age group.

The percentage of patients discharged home with or without assistance was 68.6% among 18-44 year olds and decreased to 28% among 75 year olds and older.

Of all patients in the registry, 19% died (4.6% aged 18 to 44 years; 34.3% aged 75 years and older).

This mortality trend overlapped with the level of organ support therapy patients required according to the results:

  • No organ support therapy: 8.2% (0.7% 18-44 years; 23.6% 75 years and older)
  • Invasive mechanical ventilation only: 40.8% (15.5% 18-44 years; 61.3% 75 years and older)
  • Invasive mechanical ventilation and vasopressors: 53% (28.9% 18-44 years; 74.3% 75 years and older)
  • Invasive ventilation, vasopressors and renal replacement therapy: 71.6% (50% 18-44 years; 78.3% 75 years and older)
  • Any invasive mechanical ventilation: 49.8% (25.4% 18-44 years; 68.1% 75 years and older)
  • ECMO: 35% (25.4% 18-44 years; 35.9% 75 years and older

Lal said the researchers observed “significant hospital mortality”. They reported a 1.69-fold higher death rate in patients presenting to a hospital with a higher mortality rate compared to a hospital with a lower mortality rate. He noted that this variation in mortality between hospitals is being further explored in ongoing studies.

The researchers also found that as the need for organ support increased, the changes in home discharge, with or without assistance, decreased in all age groups, but especially for the older age group, Lal said. The percentage of patients discharged home who received no organ support was 73.5 (93.2% 18-44 years; 40.9% 75 years and older), and invasive mechanical ventilation alone was 29.8% (60.3 % 18-44 years; 14.3% 75 years and older), invasive mechanical ventilation and vasopressors were 22.2% (47.5% 18-44 years; 7.2% 75 years and older), invasive mechanical ventilation , Vasopressors and renal replacement therapy were 8.8% (27.1% 18-44 years; 3.8% 75) years and older) invasive mechanical ventilation was 24.2% (50.2% 18-44 years; 10, 8% 75 years and older) and the ECMO 41.2% (48.1% 18-44 years; 48.7 75 years and older) results.

The length of stay for patients in need of organ support therapy did not vary significantly by age, Lal said.

The international VIRUS registry is a live registry, and more patients are being added to collaborative sites around the world, Lal said.

These data provide “new important information for the clinician to discuss with patients and family [of] Patients suffering from an acute infection with COVID-19, ”said Lal during the virtual presentation. “What is the expected outcome based on the organ support therapy you will need?”

The data is also helpful at the hospital and administrative levels for resource planning and resource allocation, especially in areas with limited resources, he said.

Reference:

Domecq JP et al. Crit Care Med. 2021; doi: 10.1097 / CCM.0000000000004879.

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