Determinants of Limiting Life-Sustaining Treatment in Critically Ill COVID-19 Patients: A Multicenter Study in Korean...

Understanding of the life-sustaining treatment (LST) decisions in critically ill coronavirus disease 2019 (COVID-19) patients remains limited. This study aimed to identify factors influencing LST decisions, and compare clinical outcomes between patients with, and without, LST.

This multicenter, retrospective cohort study analyzed data from 1,081 COVID-19 patients admitted to intensive care units (ICUs) across Korea from January 1, 2020, to August 31, 2021. Patients were divided into LST and non-LST groups. Demographic, clinical, and outcome data were collected and compared.

Of 1,081 patients, 207 (19.2 %) received LST. LST patients were older (median age: 76 years vs. 67 years, p<0.001), and had more comorbidities (85.5% vs. 70.4%, p<0.001), especially cardiovascular and chronic lung disease. They showed higher blood urea nitrogen, lower albumin, and elevated D-dimer levels (all p<0.05). ICU interventions, including mechanical ventilation (82.6% vs. 50.9%, p<0.001) and extracorporeal membrane oxygenation (ECMO) (18.8% vs. 9.8%, p<0.001), were more common. ICU and hospital mortality rates were significantly higher in LST patients (82.6% and 94.2%, respectively, p<0.001). Logistic regression identified age (odds ratio [OR], 1.054 per year; p<0.001), mechanical ventilation (OR, 2.789; p=0.002), and ECMO use (OR, 3.580; p=0.002) as independent predictors of LST.

Age, comorbidities, and ICU interventions significantly influence LST decisions, highlighting the need for ethical and evidence-based critical care guidelines.