Abstract
Rationale: There is an urgent need for improved understanding of the mechanisms and clinical characteristics of acute respiratory distress syndrome (ARDS) due to coronavirus disease (COVID-19). Objectives: To compare key demographic and physiologic parameters, biomarkers, and clinical outcomes of COVID-19 ARDS and ARDS secondary to direct lung injury from other etiologies of pneumonia. Methods: We enrolled 27 patients with COVID-19 ARDS in a prospective, observational cohort study and compared them with a historical, pre-COVID-19 cohort of patients with viral ARDS ( n = 14), bacterial ARDS ( n = 21), and ARDS due to culture-negative pneumonia ( n = 30). We recorded clinical demographics; measured respiratory mechanical parameters; collected serial peripheral blood specimens for measurement of plasma interleukin (IL)-6, IL-8, and IL-10; and followed patients prospectively for patient-centered outcomes. We conducted between-group comparisons with nonparametric tests and analyzed time-to-event outcomes with Kaplan-Meier and Cox proportional hazards models. Results: Patients with COVID-19 ARDS had higher body mass index and were more likely to be Black, or residents of skilled nursing facilities, compared with those with non-COVID-19 ARDS ( P < 0.05). Patients with COVID-19 had lower delivered minute ventilation compared with bacterial and culture-negative ARDS ( post hoc P < 0.01) but not compared with viral ARDS. We found no differences in static compliance, hypoxemic indices, or carbon dioxide clearance between groups. Patients with COVID-19 had lower IL-6 levels compared with bacterial and culture-negative ARDS at early time points after intubation but no differences in IL-6 levels compared with viral ARDS. Patients with COVID-19 had longer duration of mechanical ventilation but similar 60-day mortality in both unadjusted and adjusted analyses. Conclusions: COVID-19 ARDS bears several similarities to viral ARDS but demonstrates lower minute ventilation and lower systemic levels of IL-6 compared with bacterial and culture-negative ARDS. COVID-19 ARDS was associated with longer dependence on mechanical ventilation compared with non-COVID-19 ARDS. Such detectable differences of COVID-19 do not merit deviation from evidence-based management of ARDS but suggest priorities for clinical research to better characterize and treat this new clinical entity.
Keywords: COVID-19; SARS-CoV-2; acute respiratory distress syndrome; pneumonia.
【저자키워드】 COVID-19, SARS-CoV-2, acute respiratory distress syndrome, Pneumonia, 【초록키워드】 coronavirus disease, Respiratory distress syndrome, ARDS, Biomarkers, Mortality, acute respiratory distress syndrome, mechanical ventilation, Clinical characteristics, Pneumonia, IL-6, intubation, Lung injury, outcome, clinical outcomes, Clinical research, Peripheral blood, Clinical outcome, outcomes, body mass index, Viral, Culture, management, comparison, Research, Patient, IL-8, plasma, Skilled nursing facilities, IL-10, respiratory, etiology, parameters, mechanism, Bacterial, acute respiratory distress, similarity, carbon dioxide, respiratory distress, secondary to, proportional hazards models, body mass, nonparametric test, black, Observational cohort study, Non-COVID-19, Nonparametric tests, minute ventilation, static compliance, no difference, no differences, rationale, specimen, syndrome, treat, systemic level, Kaplan-Meier, clearance, deviation, hypoxemic, adjusted analyses, enrolled, analyzed, collected, detectable, conducted, groups, recorded, cohort of patient, Cox proportional hazard, IL-6 level, on mechanical ventilation, patients with COVID-19, with COVID-19, 【제목키워드】 clinical, Physiologic,