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JMIR Public Health Surveill
. 2021 Feb 17.
doi: 10.2196/24843. Online ahead of print.
Early Improvement of Acute Respiratory Distress Syndrome in Patients with COVID-19: Insights from the Data of ICU Patients in Chongqing, China
Zhu Zhan 1 2 , Xin Yang 3 , Hu Du 1 , Chuanlai Zhang 1 , Yuyan Song 4 , Xiaoyun Ran 1 , An Zhang 5 , Mei Yang 6
Affiliations
- PMID: 33630743
- DOI: 10.2196/24843
Abstract
Background: Since the start of the pandemic of coronavirus disease 2019 (COVID-19), over 2 million people has died globally. Acute respiratory distress syndrome (ARDS) may be the main cause of death.
Objective: This study aimed to describe the clinical features, outcomes, and acute respiratory distress syndrome (ARDS) characteristics of patients with COVID-19 admitted to the intensive care unit (ICU) in Chongqing, China.
Methods: The epidemiology of COVID-19 from January 21, 2020 to March 15, 2020 in Chongqing, China, was analyzed retrospectively, and 75 ICU patients from 2 hospitals were included in this study. On day 1, 56 patients with ARDS were selected for subgroup analysis, and a modified Poisson regression was performed to identify predictors for early improvement of ARDS (eiARDS).
Results: Chongqing reported a 5.3% case fatality rate of the 75 ICU patients. The median age of the ICU patients was 57 years (interquartile range, 25-75), and no bias was obtained in the sex ratio. A total of 93% of patients developed ARDS during ICU stay, and more than half had moderate ARDS. However, most of the patients (55%) were supported with high-flow nasal cannula oxygen therapy, but not mechanical ventilation. Nearly one third of patients with ARDS improved (arterial blood oxygen partial pressure/oxygen concentration >300 mm Hg) in 1 week, which was defined as early improvement of ARDS-- eiARDS. Patients with eiARDS had a higher survival rate and lower length of ICU stay than those with "non-eiARDS". Age (<55 years) was the only variable independently associated with eiARDS, with a risk ratio of 2.67 (95% confidence interval: 1.17-6.08).
Conclusions: A new subphenotype of ARDS-- eiARDS in patients with COVID-19 was identified. As clinical outcomes differ, stratified management of patients based on eiARDS or age is highly recommended.