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.