Inpatient Mortality According to Level of Respiratory Support Received for Severe Acute Respiratory Syndrome Coronavirus 2 (Coronavirus Disease 2019) Infection: A Prospective Multicenter Study

Alberto Palazzuoli; Franco Ruberto; Gaetano M De Ferrari; Giovanni Forleo; Gioel G Secco; Gaetano M Ruocco; Fabrizio D'Ascenzo; Francesco Mojoli; Silvia Monticone; Anita Paggi; Marco Vicenzi; Silvia Corcione; Anna G Palazzo; Maurizio Landolina; Erika Taravelli; Guido Tavazzi; Francesco Blasi; Massimo Mancone; Lucia I Birtolo; Francesco Alessandri; Fabio Infusino; Francesco Pugliese; Francesco Fedele; Francesco Giuseppe De Rosa; Michael Emmett; Jeffrey M Schussler; Peter A McCullough; Kristen M Tecson

doi:10.1097/CCE.0000000000000220

Inpatient Mortality According to Level of Respiratory Support Received for Severe Acute Respiratory Syndrome Coronavirus 2 (Coronavirus Disease 2019) Infection: A Prospective Multicenter Study

Crit Care Explor. 2020 Sep 18;2(9):e0220. doi: 10.1097/CCE.0000000000000220. eCollection 2020 Sep.

Authors

Alberto Palazzuoli¹, Franco Ruberto², Gaetano M De Ferrari³, Giovanni Forleo⁴, Gioel G Secco⁵, Gaetano M Ruocco⁶, Fabrizio D'Ascenzo³, Francesco Mojoli⁷, Silvia Monticone⁸, Anita Paggi⁹, Marco Vicenzi¹⁰, Silvia Corcione¹¹, Anna G Palazzo¹¹, Maurizio Landolina¹², Erika Taravelli¹², Guido Tavazzi⁷, Francesco Blasi¹³, Massimo Mancone¹⁴, Lucia I Birtolo¹⁴, Francesco Alessandri², Fabio Infusino¹⁴, Francesco Pugliese², Francesco Fedele¹⁴, Francesco Giuseppe De Rosa¹¹, Michael Emmett¹⁵, Jeffrey M Schussler^{15

16}, Peter A McCullough^{15

16

17}, Kristen M Tecson¹⁷

Affiliations

¹ Cardiovascular Diseases Unit, Department of Medical Sciences, AOUS Le Scotte Hospital, University of Siena, Siena, Italy.
² Department of General and Specialist Surgery "Paride Stefanini," Sapienza University of Rome, Rome, Italy.
³ Cardiology, Department of Medical Science, University of Turin, Città della Salute e Della Scienza Le Molinette Hospital Torino, Torino, Italy.
⁴ Section Head Electrophysiology and Cardiac Pacing, Azienda Ospedaliera-Polo Universitario-"Luigi Sacco," Milano, Italy.
⁵ Interventional Cardiology and Cardiac Surgery Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
⁶ Cardiology Division, Regina Montis Regalis Hospital Mondovì, Cuneo, Italy.
⁷ Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
⁸ Division of Internal Medicine, Department of Medical Sciences, University of Turin, Turin, Italy.
⁹ Interventional Cardiology, Department of Internal Medicine, ASSST Nord Milano E Bassini Hospital Cisanello Balsamo, Milan, Italy.
¹⁰ Cardiovascular Disease Unit, Department of Internal Medicine, University of Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
¹¹ Infectious Disease, Department of Medical Sciences, University of Torino, AOU Città della salute e della Scienza, Torino, Italy.
¹² Cardiology Division, Ospedale Maggiore of Crema, Crema, Italy.
¹³ Respiratory Unit and Adult Cystic Fibrosis Center, Department of Internal Medicine, University of Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
¹⁴ Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Roma, Italy.
¹⁵ Baylor University Medical Center, Dallas, TX.
¹⁶ Baylor Heart and Vascular Hospital, Dallas, TX.
¹⁷ Baylor Heart and Vascular Institute, Dallas, TX.

Abstract

Objectives: To describe patients according to the maximum degree of respiratory support received and report their inpatient mortality due to coronavirus disease 2019.

Design: Analysis of patients in the Coracle registry from February 22, 2020, to April 1, 2020.

Setting: Hospitals in the Piedmont, Lombardy, Tuscany, and Lazio regions of Italy.

Patients: Nine-hundred forty-eight patients hospitalized for coronavirus disease 2019.

Interventions: None.

Measurements and main results: Among 948 patients, 122 (12.87%) received invasive ventilation, 637 (67.19%) received supplemental oxygen only, and 189 (19.94%) received no respiratory support. The median (quartile 1-quartile 3) age was 65 years (54-76.59 yr), and there was evidence of differential respiratory treatment by decade of life (p = 0.0046); patients greater than 80 years old were generally not intubated. There were 606 men (63.9%) in this study, and they were more likely to receive respiratory support than women (p < 0.0001). The rate of in-hospital death for invasive ventilation recipients was 22.95%, 12.87% for supplemental oxygen recipients, and 7.41% for those who received neither (p = 0.0004). A sensitivity analysis of the 770 patients less than 80 years old revealed a lower, but similar mortality trend (18.02%, 8.10%, 5.23%; p = 0.0008) among the 14.42%, 65.71%, and 19.87% of patients treated with mechanical ventilation, supplemental oxygen only, or neither. Overall, invasive ventilation recipients who died were significantly older than those who survived (median age: 68.5 yr [60-81.36 yr] vs 62.5 yr [55.52-71 yr]; p = 0.0145).

Conclusions: Among patients hospitalized for coronavirus disease 2019, 13% received mechanical ventilation, which was associated with a mortality rate of 23%.

Keywords: coronavirus disease 2019; inpatient mortality; invasive ventilation; respiratory support; severe acute respiratory syndrome coronavirus 2; supplemental oxygen.