Intubated COVID-19 predictive (ICOP) score for early mortality after intubation in patients with COVID-19

Mitsuaki Nishikimi,Brian Lima,Santiago J Miyara,Ariana K Mcginn,Lance B Becker,Rachel Monane,Andrew J Dominello,Ernesto P Molmenti,Edith Burns,Matthew A Barish,Daniel M Rolston,Jennifer Cookingham,Douglas P Barnaby,Stuart L Cohen,Timmy Li,Cristina Sison ,Kei Hayashida,Zachary Kozel ,Koichiro Shinozaki,Rehana Rasul,Jennifer Johnson ,Muhammad Harris Shoaib ,Daniel Jafari,Jamie S Hirsch,Marc Paradis

doi:10.1038/s41598-021-00591-1

Abstract

Patients with coronavirus disease 2019 (COVID-19) can have increased risk of mortality shortly after intubation. The aim of this study is to develop a model using predictors of early mortality after intubation from COVID-19. A retrospective study of 1945 intubated patients with COVID-19 admitted to 12 Northwell hospitals in the greater New York City area was performed. Logistic regression model using backward selection was applied. This study evaluated predictors of 14-day mortality after intubation for COVID-19 patients. The predictors of mortality within 14 days after intubation included older age, history of chronic kidney disease, lower mean arterial pressure or increased dose of required vasopressors, higher urea nitrogen level, higher ferritin, higher oxygen index, and abnormal pH levels. We developed and externally validated an intubated COVID-19 predictive score (ICOP). The area under the receiver operating characteristic curve was 0.75 (95% CI 0.73–0.78) in the derivation cohort and 0.71 (95% CI 0.67–0.75) in the validation cohort; both were significantly greater than corresponding values for sequential organ failure assessment (SOFA) or CURB-65 scores. The externally validated predictive score may help clinicians estimate early mortality risk after intubation and provide guidance for deciding the most effective patient therapies.

Highlights

Coronavirus disease 2019 (COVID-19) was designated as a global pandemic in March 2020 by the World Health Organization
A total of 2182 adult intubated patients with COVID-19 admitted to all hospitals in Northwell Health system were included (n = 1546 for the derivation cohort and n = 636 for the validation cohort)
Values of OI, BUN, and ferritin were associated with increased odds of early mortality after intubation, as well as the past medical history of CKD

Summary

Introduction

Coronavirus disease 2019 (COVID-19) was designated as a global pandemic in March 2020 by the World Health Organization. 16% of the patients infected with COVID-19 showed severe acute respiratory failure[1], and 4–12% needed invasive respiratory s upport[3,4]. The in-hospital mortality rate of intubated COVID-19 patients worldwide ranges from approximately 8% to 67%5,6, but in the US, it is between 23 and 67%5. Many independent factors used to predict mortality of admitted COVID-19 patients have been reported[8,9,10,11], but none are designed exclusively for intubated patients—the most severely ill population with the highest risk of death. The aim of this study was to develop a predictive score that could identify COVID-19 patients with high risk of early mortality after intubation

Objectives

Methods

Results

Conclusion