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Risk factors for non-invasive/invasive ventilatory support in patients with COVID-19 pneumonia: A retrospective study within a multidisciplinary approach.
Suardi, Lorenzo Roberto; Pallotto, Carlo; Esperti, Sara; Tazzioli, Elisa; Baragli, Filippo; Salomoni, Elena; Botta, Annarita; Covani Frigieri, Francesca; Pazzi, Maddalena; Stera, Caterina; Carlucci, Martina; Papa, Raffaella; Meconi, Tommaso; Pavoni, Vittorio; Blanc, Pierluigi.
  • Suardi LR; Infectious Diseases Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy. Electronic address: lorenzoroberto.suardi@gmail.com.
  • Pallotto C; Infectious Diseases Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy.
  • Esperti S; Infectious Diseases Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy.
  • Tazzioli E; Infectious Diseases Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy.
  • Baragli F; Infectious Diseases Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy.
  • Salomoni E; Infectious Diseases Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy.
  • Botta A; Infectious Diseases Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
  • Covani Frigieri F; Intensive Care Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy.
  • Pazzi M; Intensive Care Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy.
  • Stera C; Intensive Care Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy; Department of Anaesthesia, University of Pisa, Pisa, Italy.
  • Carlucci M; Intensive Care Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy.
  • Papa R; Intensive Care Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy.
  • Meconi T; Intensive Care Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy.
  • Pavoni V; Intensive Care Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy.
  • Blanc P; Infectious Diseases Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno a Ripoli, Florence, Italy.
Int J Infect Dis ; 100: 258-263, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-959831
ABSTRACT

OBJECTIVES:

To investigate risk factors for non-invasive/invasive ventilatory support (NI/I-VS) in patients with coronavirus disease 2019 (COVID-19).

METHODS:

All consecutive patients admitted to the Infectious Diseases Unit and Intensive Care Unit (ICU) of Santa Maria Annunziata Hospital (Florence, Italy), from February 25 to April 25, 2020, with a confirmed COVID-19 diagnosis were enrolled in this retrospective cohort study. NI/I-VS was defined as the need for continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BPAP) (non-invasive ventilation) or mechanical ventilation, not including low-flow systems of oxygen therapy such as the Venturi mask or nasal cannula.

RESULTS:

Ninety-seven patients were enrolled; 61.9% (60/97) were male and the median patient age was 64 years. The in-hospital mortality was 9.3%. Thirty-five of the 97 patients (36%) required ICU admission and 94.8% (92/97) were prescribed oxygen therapy 10.8% (10/92) by nasal cannula, 44.5% (41/92) by Venturi mask, 31.5% (29/92) by CPAP, 2.2% (2/92) by BPAP, and 10.8% (10/92) by mechanical ventilation following intubation. On univariate analysis, patients with a body mass index >30, type II diabetes mellitus, and those presenting with dyspnoea, asthenia, SOFA score ≥2 points, PaO2/FiO2 <300, temperature >38 °C, increased levels of lactate dehydrogenase (LDH), alanine aminotransferase, and C-reactive protein, and a d-dimer >1000 ng/mL at admission more frequently underwent NI/I-VS. Multivariate logistic regression analysis confirmed temperature >38 °C (odds ratio (OR) 21.2, 95% confidential interval (95% CI) 3.5-124.5, p = 0.001), LDH >250 U/l (OR 15.2, 95% CI 1.8-128.8, p = 0.012), and d-dimer >1000 ng/mL (OR 4.5, 95% CI 1.2-17.3, p = 0.027) as significantly associated with the requirement for NI/I-VS. A non-significant trend (p = 0.051) was described for PaO2/FiO2 <300.

CONCLUSIONS:

Temperature >38 °C, LDH > 250 U/l, and d-dimer >1000 ng/mL were found to be independent risk factors for NI/I-VS in COVID-19 patients. In order to quickly identify patients likely at risk of developing a critical illness, inflammatory markers should be assessed upon hospital admission.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Int J Infect Dis Journal subject: Communicable Diseases Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Int J Infect Dis Journal subject: Communicable Diseases Year: 2020 Document Type: Article