ISSN : 2146-3123
E-ISSN : 2146-3131

Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units
Kürşat Gündoğan1, İsmail Hakkı Akbudak2, Pervin Hancı3, Burçin Halaçlı4, Şahin Temel1, Zuhal Güllü5, Kamil İnci5, Yeliz Bilir6, Firdevs Tuğba Bozkurt7, Fatma Yıldırım8, Meltem Şimşek8, Recep Civan Yüksel9, Esma Eren9, Neriman Defne Altıntaş10, Leyla Talan10, Gülseren Elay11, Göksel Güven12, İskender Kara13, Emre Aydın14, Seda Yılmaz15, Tuğçe Mengi16, Sema Sarı16, Türkay Akbaş17, Burcu Acar Cinleti18, Nazire Ateş Ayhan19, Deniz Aral Özbek4, Taha Koray Şahin4, Aslı Açıkgöz13, Ali Ümit Esbah17, et al.
1Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
2Division of Intensive Care Medicine, Department of Internal Medicine, Pamukkale University School of Medicine, Denizli, Turkey
3Division of Intensive Care Medicine, Department of Chest Diseases, Ministry of Health, Intensive Care Unit, Erzurum Training and Research Hospital, Erzurum, Turkey and Trakya University School of Medicine, Edirne, Turkey
4Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
5Intensive Care Unit, Ministry of Health, Ankara Yenimahalle Training and Research Hospital, Ankara, Turkey
6Intensive Unit, Ministry of Health, İstanbul Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
7Intensive Care Unit, Ministry of Health, Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
8Intensive Care Unit, Ministry of Health, Ankara Dışkapı Training and Research Hospital, Ankara, Turkey
9Intensive Care Unit, Ministry of Health, Kayseri City Hospital, Kayseri, Turkey
10Division of Intensive Care Medicine, Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
11Division of Intensive Care Medicine, Department of Internal Medicine, Gaziantep University School of Medicine, Gaziantep, Turkey
12Division of Intensive Care Medicine, Department of Internal Medicine, Ministry of Health, Intensive Care Unit, Tokat State Hospital, Tokat and Hacettepe University School of Medicine, Ankara, Turkey
13Department of Anesthesiology, Intensive Care Unit, Selçuk University School of Medicine, Konya, Turkey
14Division of Intensive Care Medicine, Department of Internal Medicine, Dicle University School of Medicine, Diyarbakır, Turkey
15Anesthesiology Intensive Care Unit, Kütahya Health Science University, Kütahya, Turkey
16Intensive Care Unit, Ministry of Health, Nigde Omer Halisdemir University, Nigde, Turkey
17Division of Intensive Care Medicine, Department of Internal Medicine, Düzce University School of Medicine, Düzce, Turkey
18Intensive Care Unit, Ministry of Health, İzmir Suat Seren Training and Research Hospital, İzmir, Turkey
19Division of Intensive Care Medicine, Department of Internal Medicine, Çukurova University School of Medicine, Adana, Turkey
20Division of Intensive Care Medicine, Department of Internal Medicine, Dokuz Eylül University School of Medicine, İzmir, Turkey
21Intensive Care Unit, Kırşehir Ahi Evran University, Kırşehir, Turkey
22Division of Intensive Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
23Division of Intensive Care Medicine, Department of Internal Medicine, Fırat University School of Medicine, Elazığ, Turkey
24Division of Intensive Care Medicine, Department of Chest Diseases, Çukurova University School of Medicine, Adana, Turkey
25Division of Intensive Care Medicine, Department of Chest Diseases, Dokuz Eylül University School of Medicine, İzmir, Turkey
26Division of Intensive Care Medicine, Department of Chest Diseases, Erciyes University School of Medicine, Kayseri, Turkey
DOI : 10.5152/balkanmedj.2021.21188
Pages : 296-303

Background: There are limited data on the long-term outcomes of COVID-19 from different parts of the world.
Aims: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure.
Study design: Retrospective, observational cohort.
Methods: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded.
Results: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO2/FiO2 ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050).
Conclusion: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.

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