ABSTRACT
Introduction: Severe coronavirus disease 2019 (COVID-19) is associated with cardiovascular injury and disparate outcomes in different ethnic groups. However, the reason for this difference has not been elucidated. Methods: A retrospective cross-sectional study was done on adult COVID-19 patients at a single center from April 2020 to January 2021. Mortality, length of stay, mechanical ventilation use, and intensive care unit (ICU) status were compared across demographic groups, echocardiographic indices, and COVID-19-specific treatments. Results: One hundred fifty patients were included. In univariate analysis, elevated cardiac biomarkers, COVID-19 directed therapies, and elevated right-sided pressures were associated with higher mortality, mechanical ventilation use, length of stay, and ICU admission. Multivariable logistic regression predicted higher mortality for Hispanic ethnicity (odds ratio, OR, 6.7) even when adjusting for advanced age (OR 5.3), mechanical ventilation use (OR 18), and right ventricular systolic pressure (OR 1.1 per 1mmHg). There were no differences in underlying comorbidities, echocardiographic indices, cardiac biomarkers, or treatments between Hispanic and non-Hispanic patients. Conclusions: Despite being a younger cohort, Hispanic patients had a higher rate of mortality even when controlling for age, biomarkers, and echocardiographic indices. This suggests Hispanic ethnicity is an independent risk factor for mortality in COVID-19 infection, highlighting an important health inequity that warrants further investigation.
ABSTRACT
INTRODUCTION: Intubated patients with acute respiratory distress syndrome are thought to have a 5-12% incidence of barotrauma, even with protective ventilation. However, little is known about the incidence of barotrauma in COVID-19. Due to high rates of observed barotrauma at this center, this retrospective cohort study aims to better characterize the incidence of barotrauma and identify predisposing factors such as inflammatory markers and disease severity indices for this high-mortality complication. METHODS: Inclusion criteria were as follows: age over 18 years, positive RT-PCR for SARS-CoV2, admission to the ICU between 03/15/2020 and 06/15/2020, and a score of 5 or higher on the World Health Organization's Ordinal Scale or respiratory rate over 30 breaths per minute on admission. Data were collected for the following categories developed by an internal committee of pulmonary/critical care faculty and housestaff based on similar studies: age, sex, body mass index, ferritin, d-dimer, APACHE II score, SOFA score, blood gas, ventilation mode and settings. Patients with evidence of barotrauma (pneumothorax, pneumomediastinum, pneumopericardium, subcutaneous emphysema) on imaging had additional respiratory data points collected. RESULTS: 78 patients met inclusion. Among 38 patients who received invasive mechanical ventilation (IMV) 12 had barotrauma (32%). Of 40 patients who did not receive IMV 3 had barotrauma (8%). Of 15 cases of barotrauma, 8 had pneumothorax (2 bilateral, 6 unilateral), 9 had pneumomediastinum, 4 had pneumopericardium, 6 had subcutaneous emphysema. 8 were found incidentally on imaging for non-respiratory indication. Mortality in the barotrauma group was 72% for IMV & 50% for non-IMV (3 patients transferred to other hospital, 3 remain hospitalized) compared to 50% for IMV & 8% for non-IMV in patients without barotrauma. Further analysis pending at submission, data to be finalized prior to presentation. CONCLUSIONS: Barotrauma may be an underappreciated complication of COVID-19, perhaps serving as an independent predictor of disease severity or low lung compliance. Many theories have been presented for the physiology of COVID-19 respiratory failure, but barotrauma could be evidence of or a herald sign for the low compliance phenotype.