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Timing and causes of death in severe COVID-19 patients
Charles de Roquetaillade1,2, Swann Bredin3, Jean-Baptiste Lascarrou4
1Department of Anesthesiology and Critical Care, Hôpital Lariboisière, FHU PROMICE, DMU Parabol, APHP. Nord, Paris, France.
Insights
In severe COVID-19 patients admitted to the ICU, COVID-19-related multiple organ dysfunction syndrome (MODS) and secondary infections were the leading causes of death. These critical conditions highlight key areas for intervention in intensive care settings.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonology
Background:
- Conflicting data exists regarding causes of death in severe COVID-19.
- Severe acute respiratory failure due to SARS-CoV-2 necessitates intensive care unit (ICU) admission.
- Understanding mortality patterns is crucial for improving patient outcomes.
Purpose of the Study:
- To delineate the primary causes of death in severe COVID-19 patients within the ICU.
- To analyze the timing of mortality following ICU admission for COVID-19.
- To provide a comprehensive overview of fatal outcomes in a French multicenter ICU cohort.
Main Methods:
- Retrospective analysis of 287 adult patients with confirmed SARS-CoV-2 and acute respiratory failure.
- Data collected from eight ICUs across seven French hospitals between March 1 and April 28, 2020.
- Causes and timing of death determined from medical records.
Main Results:
- 32% (93/287) of patients died in the ICU.
- COVID-19-related multiple organ dysfunction syndrome (MODS) was the leading cause (37%), followed by secondary infection-related MODS (26%).
- Refractory hypoxemia/pulmonary fibrosis (19%) and fatal ischemic events (13%) were also significant causes. Median time to death was 15 days.
Conclusions:
- COVID-19-related MODS and secondary infections are the predominant causes of death in critically ill COVID-19 patients.
- Timely identification and management of MODS and secondary infections are critical.
- Further research into preventing and treating these complications is warranted.
Background:
Previous studies reporting the causes of death in patients with severe COVID-19 have provided conflicting results. The objective of this study was to describe the causes and timing of death in patients with severe COVID-19 admitted to the intensive care unit (ICU).
Methods:
We performed a retrospective study in eight ICUs across seven French hospitals. All consecutive adult patients (aged ≥ 18 years) admitted to the ICU with PCR-confirmed SARS-CoV-2 infection and acute respiratory failure were included in the analysis. The causes and timing of ICU deaths were reported based on medical records.
Results:
From March 1, 2020, to April 28, 287 patients were admitted to the ICU for SARS-CoV-2 related acute respiratory failure. Among them, 93 patients died in the ICU (32%). COVID-19-related multiple organ dysfunction syndrome (MODS) was the leading cause of death (37%). Secondary infection-related MODS accounted for 26% of ICU deaths, with a majority of ventilator-associated pneumonia. Refractory hypoxemia/pulmonary fibrosis was responsible for death in 19% of the cases. Fatal ischemic events (venous or arterial) occurred in 13% of the cases. The median time from ICU admission to death was 15 days (25th-75th IQR, 7-27 days). COVID-19-related MODS had a median time from ICU admission to death of 14 days (25th-75th IQR: 7-19 days), while only one death had occurred during the first 3 days since ICU admission.
Conclusions:
In our multicenter observational study, COVID-19-related MODS and secondary infections were the two leading causes of death, among severe COVID-19 patients admitted to the ICU.
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