Need For Invasive Mechanical Ventilation Research Articles

Promising effects of atorvastatin on mortality and need for mechanical ventilation in patients with severe COVID-19; a retrospective cohort study.

PurposeConsidering the anti‐inflammatory effect of atorvastatin and the role of medical comorbidities such as hypertension and coronary artery disease on the prognosis of the COVID‐19 patients, we aimed to assess the effect of atorvastatin add‐on therapy on mortality caused by COVID‐19.MethodsWe conducted a retrospective cohort study, including patients who were hospitalised with confirmed diagnosis of severe COVID‐19. Baseline characteristics and related clinical data of patients were recorded. Clinical outcomes consist of in‐hospital mortality, need for invasive mechanical ventilation and hospital length of stay. COX regression analysis models were used to assess the association of independent factors to outcomes.ResultsAtorvastatin was administered for 421 of 991 patients. The mean age was 61.640 ± 17.003 years. Older age, higher prevalence of hypertension and coronary artery disease reported in patients who received atorvastatin. These patients have shorter hospital length of stay (P = .001). Based on COX proportional hazard model, in‐hospital use of atorvastatin was associated with decrease in mortality (HR = 0.679, P = .005) and lower need for invasive mechanical ventilation (HR = 0.602, P = .014).ConclusionsAtorvastatin add‐on therapy in patient with severe COVID‐19 was associated with lower in‐hospital mortality and reduced the risk of need for invasive mechanical ventilation which supports to continue the prescription of the medication.

Efficacy and safety of azithromycin in Covid-19 patients: A systematic review and meta-analysis of randomized clinical trials.

SummaryAzithromycin (AZM) is commonly used in Covid‐19 patients based on low‐quality evidence, increasing the risk of developing adverse events and antimicrobial resistance. The current systematic review and meta‐analysis investigated the safety and efficacy of AZM in treating Covid‐19 patients using published randomized controlled trials. Google Scholar, PubMed, Scopus, Cochrane Library, Clinical Trials.gov, MEDLINE, bioRxiv and medRxiv were searched for relevant studies. The random‐effects model was used to pool estimates using the Paule–Mandel estimate for heterogeneity. The odds ratio and raw difference in medians were used for dichotomous and continuous outcomes, respectively. The analysis included seven studies with 8822 patients (median age, 55.8 years; 61% males). The risk of bias was assessed as ‘low’ for five of the seven mortality results and as ‘some concerns’ and ‘high’ in one trial each. There were 657/3100 (21.2%) and 1244/5654 (22%) deaths among patients randomized to AZM and standard of care, respectively. The use of AZM was not associated with mortality in Covid‐19 patients (OR = 0.96, 95% CI 0.88–1.05, p = 0.317 based on the random‐effect meta‐analysis). The use of AZM was not associated with need for invasive mechanical ventilation (OR = 0.96, 95% CI 0.49–1.87, p = 0.85) and length of stay (Δ = 1.11, 95% CI −2.08 to 4.31, p = 0.49). The results show that using AZM as routine therapy in Covid‐19 patients is not justified due to lack of efficacy and potential risk of bacterial resistance that is not met by an increased clinical benefit.

Acute kidney injury in SARS-CoV2-related pneumonia ICU patients: a retrospective multicenter study

BackgroundWhile acute kidney injury (AKI) is frequent in severe SARS-CoV2-related pneumonia ICU patients, few data are still available about its risk factors.MethodsRetrospective observational study performed in four university affiliated hospitals in Paris. AKI was defined according to the KIDGO guidelines. Factors associated with AKI were picked up using multivariable mixed-effects logistic regression. Independent risk factors of day 28 mortality were assessed using Cox model.Results379 patients (median age 62 [53,69], 77% of male) were included. Half of the patients had AKI (n = 195, 52%) including 58 patients (15%) with AKI stage 1, 44 patients (12%) with AKI stage 2, and 93 patients (25% with AKI stage 3). Chronic kidney disease (OR 7.41; 95% CI 2.98–18.4), need for invasive mechanical ventilation at day 1 (OR 4.83; 95% CI 2.26–10.3), need for vasopressors at day 1 (OR 2.1; 95% CI 1.05–4.21) were associated with increased risk of AKI. Day 28 mortality in the cohort was 26.4% and was higher in patients with AKI (37.4 vs. 14.7%, P < 0.001). Neither AKI (HR 1.35; 95% CI 0.78–2.32) nor AKI stage were associated with mortality (HR [95% CI] for stage 1, 2 and 3 when compared to no AKI of, respectively, 1.02 [0.49–2.10], 1.73 [0.81–3.68] and 1.42 [0.78–2.58]).ConclusionIn this large cohort of SARS-CoV2-related pneumonia patients admitted to the ICU, AKI was frequent, mostly driven by preexisting chronic kidney disease and life sustaining therapies, with unclear adjusted relationship with day 28 outcome.

No evidence of tocilizumab treatment efficacy for severe to critical SARS-CoV2 infected patients: Results from a retrospective controlled multicenter study.

To assess tocilizumab (TCZ) efficacy associated to standard of care (SOC) compared to SOC alone in severe coronavirus associated disease 2019 (COVID-19) patients. In a matched case-control study from 3 French Hospital COVID-19 Departments, 27 patients with severe COVID-19 treated with TCZ and SOC were matched for baseline epidemiological and clinical features and compared to 27 severe COVID-19 patients treated with SOC alone. Baseline characteristics of the study population were comparable between groups. Eleven patients (20%) died. TCZ was not associated with clinical improvement as compared to SOC regarding oxygen-free status (44% vs 63%) and death (18.5% vs 22%), despite a higher decrease of the C-reactive protein at Day 7 (10.7 vs 52 mg/L; P < 10−3). Compared to the 43 patients alive at the end-of follow-up, patients who died were older (78 vs 64 years; P < 10−3), with 82% of them older than 72 years vs only 23% of live patients (P < 10−3). Age (OR = 1.15; 95%CI = 1.04–1.3; P = .008) and age over 72 years (OR) = 14.85; 95%CI = 2.7–80; P = .002) were independently associated with mortality. TCZ in addition to SOC for severe COVID-19 patients did not reduce mortality, subsequent need for invasive mechanical ventilation nor did it shorten the time of oxygen support, despite better control of the inflammatory response. More powerful and randomized controlled trials are warranted to determine if TCZ is effective in the management of COVID-19.

Invasive mechanical ventilation at 36 weeks post-menstrual age, adverse outcomes with a comparison of recent definitions of bronchopulmonary dysplasia

ObjectivesTo determine whether the need for invasive mechanical ventilation (iMV) at 36 weeks PMA in patients with severe bronchopulmonary dysplasia (sBPD) identifies those patients at highest risk for tracheostomy or gastrostomy, and to compare sBPD with recent definitions of BPD.Study designObservational study from Jan 2015 to Sept 2019 using data from the BPD Collaborative Registry.ResultsFive hundred and sixty-four patients with sBPD of whom 24% were on iMV at 36 weeks PMA. Those on iMV had significantly (p < 0.0001) increased risk for tracheostomy or gastrostomy. The overall mortality rate was 3% and the risk for mortality was substantially greater in those on iMV than in those on noninvasive support at 36 weeks PMA (RR 13.8, 95% CI 4.3–44.5, p < 0.0001). When applying the NICHD definition (2016) 44% had Grade III BPD. When applying the NRN definition, 6% had Grade 1 BPD, 70% had Grade 2 BPD, and 24% had Grade 3 BPD.ConclusionsPatients with sBPD who were on iMV at 36 weeks had a significantly greater risk of inhospital mortality and survivors had a significantly greater risk of undergoing tracheostomy and/or gastrostomy. The use of type 2 sBPD or Grade 3 BPD would enhance the ability to target future studies to those infants with sBPD at the highest risk of adverse long-term outcomes.

Vitamin D supplementation for the treatment of COVID-19: a living systematic review.

Abstract available in English Español فارسی Français 한국어 Português ภาษาไทย 简体中文

Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review.

Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review.

Anakinra in hospitalized non-intubated patients with coronavirus disease 2019: a Systematic review and meta-analysis.

BackgroundAcute respiratory distress syndrome and cytokine release syndrome are the major complications of coronavirus disease 2019 (COVID-19) associated with increased mortality risk.ObjectivesWe performed a meta-analysis to assess the efficacy and safety of anakinra in adult hospitalized non-intubated patients with COVID-19.Search methodsRelevant trials were identified by searching literature until 24 April 2021 using the following terms: anakinra, interleukin 1, coronavirus, COVID-19, SARS-CoV-2.Selection criteriaTrials evaluating the effect of anakinra on the need for invasive mechanical ventilation and mortality in hospitalized non-intubated patients with COVID-19.ResultsNine studies (n = 1,119) were eligible for inclusion in the present meta-analysis. Their bias risk with reference to the assessed parameters was high. In pooled analyses, anakinra reduced the need for invasive mechanical ventilation (odds ratio, OR: 0·38, 95% confidence interval, CI: 0·17–0·85, p= 0.02, I2=67%; 6 studies, n = 587) and mortality risk (OR: 0·32, 95% CI: 0·23–0·45, p< 0·00001, I2=0%; 9 studies, n = 1,119) compared with standard of care therapy. There were no differences regarding the risk of adverse events, including liver dysfunction (OR: 0·75, 95% CI: 0·48–1·16, p> 0·05, I2=28%; 5 studies, n = 591) and bacteremia (OR: 1·07, 95% CI: 0·42–2·73, p> 0·05, I2=71%; 6 studies, n = 727).ConclusionsAvailable evidence shows that treatment with anakinra reduces both the need for invasive mechanical ventilation and mortality risk of hospitalized non-intubated patients with COVID-19 without increasing the risk of adverse events. Confirmation of efficacy and safety requires randomized placebo-controlled trials.

Hematolojik kanser tanısıyla yoğun bakım ünitesinde takip edilen hastaların klinik özelliklerinin ve sonuçlarının değerlendirilmesi: tek merkez deneyimi

Introduction: Patients diagnosed with hematological cancer (HC) often need intensive care during their follow-up and treatment. In this study, it was aimed to evaluate the clinical characteristics and follow-up results of patients diagnosed with HC who were followed up in the intensive care unit (ICU). Materials and methods: This is a retrospective study enrolling 77 adult HC patients requiring intensive care between February 2019 and March, 2020. Results: Thirty-eight (50.6%) patients included in the study were neutropenic and 67 patients (87%) had infection during admission to the ICU. Acute myeloid leukemia was diagnosed in 35 (45.5%) patients. Mechanical ventilation was applied to 56 (72.7%) patients on admission. In the follow-up, 32 (41.6%) patients developed ICU infection, 24 (31.2%) patients developed bacteremia. The most common pathogens were; Klebsiella pneumonia (n = 11, 14.3%) and non-fermentation bacteria (n = 13, 16.6%) were gram-negative bacilli. Overall ICU survival rate was 32.5% (n: 25). Variables predicted to affect mortality in univariate analysis; APACHE II score ≥ 25 (p <0.001), resistance to cancer treatment or relapse (p = 0.015), septic shock at hospitalization (p <0.001), need for invasive mechanical ventilation (p <0.001) and presence of hospital infection (p = 0.006) were statistically were found to be significant risk factors. As a result of the multivariate model established with these variables, it was seen that the APACHE II score was a significant predictor for mortality (ROC: 0.884). Conclusion: APACHE II score 25 and septic shock are important poor prognosis criteria. Successful treatment and long survival can be achieved by the protocols to be determined in the follow-up and treatment of HC patients in need of intensive care, supportive treatments and prevention of nosocomial infections.

Feasibility of Pediatric Non-Invasive Respiratory Support in Low- and Middle-Income Countries

Non-Invasive respiratory support can be viewed as mechanical respiratory support without endotracheal intubation and it includes continuous positive airway pressure, bi-level positive airway pressure, high flow nasal cannula, and non-invasive positive pressure ventilation. Over past few years, non-invasive respiratory support is getting more popular across pediatric intensive care units for acute respiratory failure as well as for long-term ventilation support at home. It reduces the need for invasive mechanical ventilation, decreases the risk of nosocomial pneumonia as well as mortality in selected pediatric and adult population. Unfortunately, majority of available studies on non-invasive respiratory support have been conducted in high-income countries, which are different from low-and middle-income countries (LMICs) in terms of resources, manpower, and the disease profile. Hence, we need to consider disease profile, severity at hospital presentation, availability of age-appropriate equipment, ability of healthcare professionals to manage patients on non-invasive respiratory support, and cost-benefit ratio. In view of the relatively high cost of equipment, there is a need to innovate to develop indigenous kits/devices with available resources in LMICs to reduce the cost and potentially benefit health system. In this review, we highlight the role of non-invasive respiratory support in different clinical conditions, practical problems encountered in LMICs setting, and few indigenous techniques to provide non-invasive respiratory support.

Miraculous recovery after severe coronavirus disease-19 in old age patient: A rare case Report

A novel severe acute respiratory syndrome coronavirus 2 led to an ongoing coronavirus disease (COVID)-19 pandemic since December 2019. It has affected all age groups; however, older adults are particularly susceptible to the virus and develop severe symptoms, and frequently require critical care admissions. They often require long-term home-based care and multidisciplinary rehabilitation programs. Here, we report a case of complete clinical recovery of a 74-year-old female with no post-COVID sequelae despite severe acute respiratory distress syndrome, multiple comorbidities, and the need for invasive mechanical ventilation. We believe that this case report can further guide the physicians to manage such critical cases.

Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives.

Purpose of ReviewA growing body of evidence suggests that obesity and increased visceral adiposity are strongly and independently linked to adverse outcomes and death due to COVID-19. This review summarizes current epidemiologic data, highlights pathogenetic mechanisms on the association between excess body weight and COVID-19, compares data from previous pandemics, discusses why COVID-19 challenges the “obesity paradox,” and presents implications in prevention and treatment as well as future perspectives.Recent FindingsData from meta-analyses based on recent observational studies have indicated that obesity increases the risks of infection from SARS-CoV-2, severe infection and hospitalization, admission to the ICU and need of invasive mechanical ventilation (IMV), and the risk of mortality, particularly in severe obesity. The risks of IMV and mortality associated with obesity are accentuated in younger individuals (age ≤ 50 years old). The meta-inflammation in obesity intersects with and exacerbates underlying pathogenetic mechanisms in COVID-19 through the following mechanisms and factors: (i) impaired innate and adaptive immune responses; (ii) chronic inflammation and oxidative stress; (iii) endothelial dysfunction, hypercoagulability, and aberrant activation of the complement; (iv) overactivation of the renin–angiotensin–aldosterone system; (v) overexpression of the angiotensin-converting enzyme 2 receptor in the adipose tissue; (vi) associated cardiometabolic comorbidities; (vii) vitamin D deficiency; (viii) gut dysbiosis; and (ix) mechanical and psychological issues.SummaryMechanistic and large epidemiologic studies using big data sources with omics data exploring genetic determinants of risk and disease severity as well as large randomized controlled trials (RCTs) are necessary to shed light on the pathways connecting chronic subclinical inflammation/meta-inflammation with adverse COVID-19 outcomes and establish the ideal preventive and therapeutic approaches for patients with obesity.

Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study

PurposeAdequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course.MethodsA cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed.ResultsForty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10–1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00–16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26–46.75, vs 18 days, IQR 16–46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6–15.5) for non-IMV and 49.5 days (IQR 36.8–82.5) for IMV patients.ConclusionsOur results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19.

Non-invasive respiratory support strategies in COVID-19

Non-invasive respiratory support strategies in COVID-19

Nasal High-Frequency Oscillatory Ventilation in Preterm Infants with Moderate Respiratory Distress Syndrome: A Multicenter Randomized Clinical Trial

Objective: To determine whether nasal high-frequency oscillatory ventilation (NHFOV) as a primary mode of respiratory support as compared with nasal continuous airway pressure (NCPAP) will reduce the need for invasive mechanical ventilation in preterm infants (26^0/7–33^6/7 weeks of gestational age [GA]) with respiratory distress syndrome (RDS). Methods: This multicenter randomized controlled trial was conducted in 18 tertiary neonatal intensive care units in China. A total of 302 preterm infants born at a GA of 26^0/7–33^6/7 weeks with a diagnosis of RDS were randomly assigned to either the NCPAP (n = 150) or the NHFOV (n = 152) group. The primary outcome was the need for invasive mechanical ventilation during the first 7 days after birth. Results: Treatment failure occurred in 15 of 152 infants (9.9%) in the ­NHFOV group and in 26 of 150 infants (17.3%) in the NCPAP group (95% CI of risk difference: −15.2 to 0.4, p = 0.06). In the subgroup analysis, NHFOV resulted in a significantly lower rate of treatment failure than did NCPAP in the strata of 26^+0/7–29^+6/7weeks of GA (11.9 vs. 32.4%, 95% CI of risk difference: −39.3 to −1.7, p = 0.03) and birth weight <1,500 g (10.4 vs. 29.6%, 95% CI of risk difference: −33.8 to −4.6, p = 0.01). The rate of thick secretions causing an airway obstruction was higher in the NHFOV group than in the NCPAP group (13.8 vs. 5.3%, 95% CI of risk difference: 1.9–15.1, p = 0.01). No significant differences in other secondary outcomes were found between the NHFOV and NCPAP groups. Conclusions: NHFOV was not superior to NCPAP with regard to the primary outcome when applied as the primary respiratory support for RDS in infants between 26^+0/7 and 33^+6/7 weeks of GA. In the subgroup analysis, NHFOV seemed to improve effectiveness than NCPAP in preterm infants <30 weeks of GA.

COVID-IRS: A novel predictive score for risk of invasive mechanical ventilation in patients with COVID-19.

Coronavirus disease 2019 (COVID-19) is a systemic disease that can rapidly progress into acute respiratory failure and death. Timely identification of these patients is crucial for a proper administration of health-care resources. To develop a predictive score that estimates the risk of invasive mechanical ventilation (IMV) among patients with COVID-19. Retrospective cohort study of 401 COVID-19 patients diagnosed from March 12, to August 10, 2020. The score development cohort comprised 211 patients (52.62% of total sample) whereas the validation cohort included 190 patients (47.38% of total sample). We divided participants according to the need of invasive mechanical ventilation (IMV) and looked for potential predictive variables. We developed two predictive scores, one based on Interleukin-6 (IL-6) and the other one on the Neutrophil/Lymphocyte ratio (NLR), using the following variables: respiratory rate, SpO2/FiO2 ratio and lactic dehydrogenase (LDH). The area under the curve (AUC) in the development cohort was 0.877 (0.823-0.931) using the NLR based score and 0.891 (0.843-0.939) using the IL-6 based score. When compared with other similar scores developed for the prediction of adverse outcomes in COVID-19, the COVID-IRS scores proved to be superior in the prediction of IMV. The COVID-IRS scores accurately predict the need for mechanical ventilation in COVID-19 patients using readily available variables taken upon admission. More studies testing the applicability of COVID-IRS in other centers and populations, as well as its performance as a triage tool for COVID-19 patients are needed.

Impact of Body Mass Index on COVID-19-Related In-Hospital Outcomes and Mortality.

BackgroundGiven the high prevalence of obesity around the globe, patients with coronavirus disease 2019 (COVID-19) are at an increased risk of devastating complications.MethodsA retrospective cohort study was performed to determine the association of basal metabolic index (body mass index (BMI)) with the need for invasive mechanical ventilation (IMV), dialysis, upgrade to an intensive care unit (ICU) and mortality. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aORs) with its 95% confidence interval (CI), respectively.ResultsA total of 176 consecutive patients with confirmed COVID-19 diagnosis were included. The mean age was 62.2 years, with 51% being male patients. The mean BMI for non-surviving patients was significantly higher compared to patients surviving on the seventh day of hospitalization (35 vs. 30 kg/m2, P = 0.022). Similarly, patients requiring IMV had a higher BMI (33 vs. 29, P = 0.002) compared to non-intubated patients. The unadjusted OR for patients with a higher BMI requiring IMV (56% vs. 28%, OR: 3.3, 95% CI: 1.6 - 7.0, P = 0.002) and upgrade to ICU (46% vs. 28%, OR; 2.2, 1.07 - 4.6, P = 0.04) were significantly higher compared to patients with a lower BMI. Similarly, patients with a higher BMI had higher in-hospital mortality (21% vs. 9%, OR: 3.2, 95% CI: 1.3 - 8.2, P = 0.01) compared to patients with a normal BMI. Despite a numerical advantage in the lower BMI group, there was no significant difference between the two groups in terms of the need for dialysis (5% vs. 13%, OR: 3.8, 13% vs. 4%, 1.1 - 14.1, P = 0.07). aORs controlled for baseline comorbidities and medications mirrored the overall results, except for the need to upgrade to ICU.ConclusionsIn patients with confirmed COVID-19, morbid obesity serves as an independent risk factor of high in-hospital mortality and the need for IMV.

Prior Treatment with Statins is Associated with Improved Outcomes of Patients with COVID-19: Data from the SEMI-COVID-19 Registry.

BackgroundThe impact of statins on COVID-19 outcomes is important given the high prevalence of their use among individuals at risk for severe COVID-19. Our aim is to assess whether patients receiving chronic statin treatment who are hospitalized with COVID-19 have reduced in-hospital mortality if statin therapy is maintained during hospitalization.MethodsThis work is a cross-sectional, observational, retrospective multicenter study that analyzed 2921 patients who required hospital admission at 150 Spanish centers included in the nationwide SEMI-COVID-19 Network. We compared the clinical characteristics and COVID-19 disease outcomes between patients receiving chronic statin therapy who maintained this therapy during hospitalization versus those who did not. Propensity score matching was used to match each statin user whose therapy was maintained during hospitalization to a statin user whose therapy was withdrawn during hospitalization.ResultsAfter propensity score matching, continuation of statin therapy was associated with lower all-cause mortality (OR 0.67, 0.54–0.83, p < 0.001); lower incidence of acute kidney injury (AKI) (OR 0.76,0.6–0.97, p = 0.025), acute respiratory distress syndrome (ARDS) (OR 0.78, 0.69- 0.89, p < 0.001), and sepsis (4.82% vs 9.85%, p = 0.008); and less need for invasive mechanical ventilation (IMV) (5.35% vs 8.57, p < 0.001) compared to patients whose statin therapy was withdrawn during hospitalization.ConclusionsPatients previously treated with statins who are hospitalized for COVID-19 and maintain statin therapy during hospitalization have a lower mortality rate than those in whom therapy is withdrawn. In addition, statin therapy was associated with a decreased probability that patients with COVID-19 will develop AKI, ARDS, or sepsis and decreases the need for IMV.

Fatality and risk features for prognosis in COVID-19 according to the care approach - a retrospective cohort study.

IntroductionThis study analyzed the impact of a categorized approach, based on patients’ prognosis, on major outcomes and explanators in patients hospitalized for COVID-19 pneumonia in an academic center in Spain.MethodsRetrospective cohort study (March 3 to May 2, 2020). Patients were categorized according to the followed clinical management, as maximum care or limited therapeutic effort (LTE). Main outcomes were all-cause mortality and need for invasive mechanical ventilation (IMV). Baseline factors associated with outcomes were analyzed by multiple logistic regression, estimating odds ratios (OR; 95%CI).ResultsThirty-hundred and six patients were hospitalized, median age 65.0 years, 57.8% males, 53.3% Charlson index ≥3. The overall all-cause fatality rate was 15.0% (n = 46). Maximum care was provided in 238 (77.8%), IMV was used in 38 patients (16.0%), and 5.5% died. LTE was decided in 68 patients (22.2%), none received IMV and fatality was 48.5%. Independent risk factors of mortality under maximum care were lymphocytes <790/mm3, troponin T >15ng/L and hypotension. Advanced age, lymphocytes <790/mm3 and BNP >240pg/mL independently associated with IMV requirement.ConclusionOverall fatality in the cohort was 15% but markedly varied regarding the decided approach (maximum care versus LTE), translating into nine-fold higher mortality and different risk factors.

Clinical course, maternal and neonatal outcomes of COVID-19 infection in pregnancy: an epidemiological study in Siberia and the Far East

Aim. To assess the incidence, clinical course, outcomes of a novel coronavirus infection (NKI) COVID-19 for mother and child in the population of pregnant women in the Far Eastern (FEFD) and Siberian Federal Districts (SFD).&#x0D; Materials and methods. The study design: a population-based epidemiological prospective study. We analyzed operative information on NKI COVID-19 incidence and features of clinical course in pregnant women, women in labor and parturient women as well as maternal and perinatal outcomes for March 11 to December 25, 2020 which were provided by the FEFD and SFD chief obstetricians-gynecologists. Mathematical analysis included methods of descriptive statistics, analysis of contingency table, where the value of 2, the achieved level of significance (p) was estimated.&#x0D; Results. In the FEFD and SFD, over the COVID-19 2020 epidemic, the SARS-CoV-2 virus was revealed in 8485 pregnant women, women in labor and postpartum women (5.9% of pregnant women subjected to regular medical check-up; 1.71% of the sick entire population). The incidence rate in pregnant women was 3.0 times higher than in the entire population: 5933,2 vs 1960,8 per 100 thousand (p0.001). Among SARS-CoV-2 infected patients, 27.4% (2324) were asymptomatic, 52.7% (4471) have mild, 16.6% (1388) moderate, 2.5% (210) severe 0,5% (39) extremely severe clinical course. In the intensive care and anesthesiology departments, 3.57% of pregnant women and 2.24% of the entire population (p0.001) have been treated. Rate of using invasive artificial lung ventilation in pregnant women was lower than in the population: 0.48% vs 1.05% (p0.001). 27.97% (2373) of women with confirmed NKI COVID-19 completed pregnancy. 81,7% of mothers delivered on time, 18.3% prematurely. Cesarean delivery was performed in 42,0% of women, operative vaginal delivery (vacuum extraction, obstetric forceps) was registered in 0.2% of cases. 12 (0.14%) mothers died. The maternal mortality rate was 505.69 per 100 thousand live births (0.51% of patients with COVID-19 who gave birth). Mortality rates and the proportion of deaths in the entire population were statistically significantly higher: 1948.93 per 100 thousand sick population and 1.95% (p0.001), respectively. 37 (1.56%) cases of perinatal losses were registered, of which 31 (1.30%) stillbirths, 6 (0.26%) early neonatal mortality. The SARS-CoV-2 virus was revealed in 148 (6.2%) newborns with the observance of anti-epidemic measures and separation of the mother and child immediately after delivery.&#x0D; Conclusion. The rate of revealing SARS-CoV-2 virus in pregnant women, women in labor and parturient women in Siberia and the Far East was 3.0 times higher than in the entire population, while clinical course of infectious process was less severe (less need for invasive mechanical ventilation, lower mortality rate). In mothers with COVID-19, preterm birth rate was 3.0 times higher, caesarean delivery rate 1.4 times higher compared with the average population indicators. Reveling SARS-CoV-2 virus RNA in 6.2% of newborns suggests the possibility of vertical transmission of the infection.