| المؤلفون: |
Ursino, Moreno1,2 (AUTHOR) moreno.ursino@inserm.fr, Dupuis, Claire3,4 (AUTHOR) cdup83@gmail.com, Buetti, Niccolò4 (AUTHOR) lila.bouadma@aphp.fr, de Montmollin, Etienne4,5 (AUTHOR) stephane.ruckly@gmail.com, Bouadma, Lila4,5 (AUTHOR) jean-francois.timsit@aphp.fr, Golgran-Toledano, Dany6 (AUTHOR) daniele.goldgran-toledano@ght-gpne.fr, Ruckly, Stéphane4,7 (AUTHOR), Neuville, Mathilde8 (AUTHOR) m.neuville@hopital-foch.com, Cohen, Yves9,10,11 (AUTHOR) yves.cohen@aphp.fr, Mourvillier, Bruno12 (AUTHOR) bmourvillier@chu-reims.fr, Souweine, Bertrand3 (AUTHOR) bsouweine@chu-clermontferrand.fr, Gainnier, Marc13 (AUTHOR) marc.gainnier@ap-hm.fr, Laurent, Virginie14 (AUTHOR) vlaurent@ch-versailles.fr, Terzi, Nicolas15,16 (AUTHOR) nterzi@chu-grenoble.fr, Shiami, Shidasp17 (AUTHOR) shidasp.siami@ch-sudessonne.fr, Reignier, Jean18 (AUTHOR) jean.reignier@chu-nantes.fr, Alberti, Corinne1,19 (AUTHOR) corinne.alberti@inserm.fr, Timsit, Jean-François4,5 (AUTHOR), Froelich, Michael A. (AUTHOR) |
| مستخلص: |
The mortality of COVID-19 patients in the intensive care unit (ICU) is influenced by their state at admission. We aimed to model COVID-19 acute respiratory distress syndrome state transitions from ICU admission to day 60 outcome and to evaluate possible prognostic factors. We analyzed a prospective French database that includes critically ill COVID-19 patients. A six-state multistate model was built and 17 transitions were analyzed either using a non-parametric approach or a Cox proportional hazard model. Corticosteroids and IL-antagonists (tocilizumab and anakinra) effects were evaluated using G-computation. We included 382 patients in the analysis: 243 patients were admitted to the ICU with non-invasive ventilation, 116 with invasive mechanical ventilation, and 23 with extracorporeal membrane oxygenation. The predicted 60-day mortality was 25.9% (95% CI: 21.8%–30.0%), 44.7% (95% CI: 48.8%–50.6%), and 59.2% (95% CI: 49.4%–69.0%) for a patient admitted in these three states, respectively. Corticosteroids decreased the risk of being invasively ventilated (hazard ratio (HR) 0.59, 95% CI: 0.39–0.90) and IL-antagonists increased the probability of being successfully extubated (HR 1.8, 95% CI: 1.02–3.17). Antiviral drugs did not impact any transition. In conclusion, we observed that the day-60 outcome in COVID-19 patients is highly dependent on the first ventilation state upon ICU admission. Moreover, we illustrated that corticosteroid and IL-antagonists may influence the intubation duration. [ABSTRACT FROM AUTHOR] |
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