PREDICTOR VARIABLES FOR MORTALITY IN THE 48 HOURS PRIOR TO ENDOTRACHEAL INTUBATION IN PATIENTS WITH COVID-19 PNEUMONIA

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The possibility that the capacity to provide mechanical ventilation may be overwhelmed during a COVID19 surge led to the development of ventilator triage policies, most of which used the sequential organ failure assessment (SOFA) score as a measure of potential for short term survival. A recent study, however, showed that the discriminant accuracy of the SOFA score for predicting survival in patients being intubated for COVID19 was extremely poor. Therefore, our aim was to identify variables occurring 48 hours prior to intubation for COVID19, which are associated with mortality by univariate analysis. These might be used in a future multivariate model to aid triage decisions. METHODS: This was a retrospective cohort study in 18 ICUs in the southwestern United States between March 1 and August 31, 2020. Patients >18 years with diagnosis of COVID-19 pneumonia receiving oxygen therapy >4 hours prior to endotracheal intubation were included. The main outcome variable was hospital mortality or hospice discharge. Possible predictor variables included age, gender, race/ethnicity, BMI, medications, CRP, D-dimer, BNP, creatinine, bilirubin, P/F ratio, platelets, Glasgow Coma Scale score, length of stay, SOFA score and comorbidities including diabetes, hypertension (HTN), coronary artery disease (CAD) and COPD. We compared frequency of each variable in patients who survived versus those who did not. Categorical variables were compared using chi-square test. Continuous variables were compared using T-test or Wilcoxon Rank Sum test as appropriate. Stata version 15 (StataCorp) was used. RESULTS: Of 2546 patients with COVID19 infection, 675 met study inclusion criteria. Median age was 63 years and 60% were men. 38 % were non-Hispanic white, 42% Hispanic, 10% Native American, and 4% African American. 400 (59%) died or were discharged to hospice. Non-survivors were more likely to be older (p=0.001), men (p=0.007), with higher BNP (p=0.007)and D-dimer (p=0.0001)and lower BMI (p=0.001)and P/F ratio (p=0.0008)and to have received insulin (p=0.003), and have history of HTN (p<0.001) and CAD (p=0.001). There was no relationship between mortality and racial/ethnic groups. CONCLUSIONS: Older age, male gender, lower BMI within obesity range (30-35), insulin use, elevated D-dimer, and BNP and comorbid HTN and CAD were found to be significantly associated with death by univariate analysis. We found no racial disparity in mortality outcomes among non-Hispanic whites, white, Native American, or African American patients in our study population. CLINICAL IMPLICATIONS: We plan to use these variables in the development and testing of a multivariate scoring system to predict probability of death in patients requiring mechanical ventilation for COVID19 pneumonia and to build a web-based calculator tool which could generate a prediction score. This could have utility in ventilator triage decisions at a critical juncture in the COVID19 hospitalization. DISCLOSURES: No relevant relationships by Sumit Agarwal, source=Web Response No relevant relationships by Craig Heise, source=Web Response No relevant relationships by Pooja Rangan, source=Web Response No relevant relationships by robert raschke, source=Web Response No relevant relationships by Nehan Sher, source=Web Response No relevant relationships by Suresh Uppalapu, source=Web Response