Abstract
Abstract Background Point-of-care ultrasound (POCUS) is a useful diagnostic tool for non-invasive assessment of critically ill patients. Mortality of elderly patients with COVID-19 pneumonia is high and there is still scarcity of definitive predictors. Aim of our study was to assess the prediction value of combined lung and heart POCUS data on mortality of elderly critically ill patients with severe COVID-19 pneumonia. Methods This was a retrospective observational study. Data of patients older than 70 years, with severe COVID-19 pneumonia admitted to 25-bed mixed, level 3, intensive care unit (ICU) was analyzed retrospectively. POCUS was performed at admission; our parameters of interest were pulmonary artery systolic pressure (PASP) and presence of diffuse B-line pattern (B-pattern) on lung ultrasound. Results Between March 2020 and February 2021, 117 patients aged 70 years or more (average age 77±5 years) were included. Average length of ICU stay was 10.7±8.9 days. High-flow oxygenation, non-invasive ventilation and invasive mechanical ventilation were at some point used to support 36/117 (31%), 39/117 (33%) and 75/117 (64%) patients respectively. ICU mortality was 50.9%. ICU stay was shorter in survivors (8.8±8.3 vs 12.6±9.3 days, p=0.02). PASP was lower in ICU survivors (32.5±9.8 vs. 40.4±14.3 mmHg, p=0.024). B-pattern was more often detected in non-survivals (35/59 (59%) vs. 19/58 (33%), p=0.005). PASP and B-pattern at admission were both univariate predictors of mortality. PASP at admission was an independent predictor of ICU (OR 1.0683, 95%CI: 1.0108-1.1291, p=0.02) and hospital (OR 1.0813, 95%CI 1.0125-1.1548, p=0.02) mortality. Ventilator associated pneumonia (VAP) was a strong predictor of ICU and hospital mortality. Conclusions PASP at admission is an independent predictor of ICU and hospital mortality of elderly patients with severe COVID-19 pneumonia. During ICU stay development of VAP was a strong predictor of ICU and hospital mortality.
Highlights
Coronavirus disease 2019 (COVID-19) is a multi-system disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1]In-hospital mortality of older hospitalised COVID-19 patients is high.[2]
In laboratory data we focused on admission data and on clinically worst laboratory data during the whole intensive care unit (ICU) stay (i.e., lowest pH, highest partial pressure of carbon dioxide (pCO2), lowest partial pressure of oxygen (pO2), highest d-dimer, highest troponin T, highest procalcitonin (PCT), highest C-reactive protein (CRP), highest creatinine, highest leucocyte counts, etc.)
Three-hundred-forty-three patients were admitted into ICU during the study period. 208 patients, who were younger than 70 years and 28 patients, who had previously detected pulmonary hypertension/or left heart failure, were excluded. 117 patients were included in the final analysis, ICU survivors and non-survivors
Summary
In-hospital mortality of older hospitalised COVID-19 patients is high.[2]. Frailty is independently associated with higher in-hospital mortality, even though COVID-19 patients with frailty presented earlier to the hospital with less severe symptoms.[2]. Factors associated with mortality of elderly people diagnosed with SARS-CoV-2 who lived in institutions or who were hospitalized because of the disease were dementia, diabetes, chronic kidney disease and hypertension.[3]. Point-of-care ultrasound (POCUS) is a useful diagnostic tool for non-invasive assessment of critically ill patients. Mortality of elderly patients with COVID-19 pneumonia is high and there is still scarcity of definitive predictors. Aim of our study was to assess the prediction value of combined lung and heart POCUS data on mortality of elderly critically ill patients with severe COVID-19 pneumonia
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