Pulmonary hypertension at admission predicts ICU mortality in elderly critically ill with severe COVID-19 pneumonia: retrospective cohort study.

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Ultrasound Pub Date : 2023-01-18 DOI:10.1186/s12947-023-00300-0

Marko Kurnik, Helena Božič, Anže Vindišar, Petra Kolar, Matej Podbregar

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引用次数: 2

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 mixed 25-bed, 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 October 2020 and March 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-survivors (35/59 (59%) vs. 19/58 (33%), p = 0.005). PASP and B-pattern at admission, and also mechanical ventilation and development of VAP, were univariate predictors of mortality. PASP at admission was an independent predictor of ICU (OR 1.061, 95%CI 1.003-1.124, p = 0.039) and hospital (OR 1.073, 95%CI 1.003-1.146, p = 0.039) mortality.

Conclusions: Pulmonary artery systolic pressure at admission is an independent predictor of ICU and hospital mortality of elderly patients with severe COVID-19 pneumonia.

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入院时肺动脉高压可预测老年重症COVID-19肺炎ICU死亡率:回顾性队列研究

背景:即时超声(POCUS)是一种对危重患者进行无创评估的有用诊断工具。老年COVID-19肺炎患者的死亡率很高，但仍缺乏明确的预测指标。本研究的目的是评估肺、心联合POCUS数据对老年重症COVID-19肺炎患者死亡率的预测价值。方法:回顾性观察性研究。回顾性分析25张床位三级混合重症监护病房(ICU)收治的70岁以上重症COVID-19肺炎患者资料。入院时进行POCUS;我们感兴趣的参数是肺动脉收缩压(PASP)和肺超声弥漫性b线型(b型)的存在。结果:2020年10月至2021年3月，纳入117例70岁及以上患者(平均年龄77±5岁)。ICU平均住院时间为10.7±8.9天。高流量氧合、无创通气和有创机械通气分别支持36/117(31%)、39/117(33%)和75/117(64%)患者。ICU死亡率为50.9%。幸存者在ICU的住院时间较短(8.8±8.3天vs 12.6±9.3天，p = 0.02)。ICU存活患者PASP较低(32.5±9.8比40.4±14.3 mmHg, p = 0.024)。b型在非幸存者中更常见(35/59(59%)比19/58 (33%)，p = 0.005)。入院时的PASP和b型，以及机械通气和VAP的发展是死亡率的单因素预测因素。入院PASP是ICU (OR 1.061, 95%CI 1.003-1.124, p = 0.039)和住院(OR 1.073, 95%CI 1.003-1.146, p = 0.039)死亡率的独立预测因子。结论:入院时肺动脉收缩压是老年重症COVID-19肺炎患者ICU和住院死亡率的独立预测因子。

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来源期刊

Cardiovascular Ultrasound CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.10

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Cardiovascular Ultrasound is an online journal, publishing peer-reviewed: original research; authoritative reviews; case reports on challenging and/or unusual diagnostic aspects; and expert opinions on new techniques and technologies. We are particularly interested in articles that include relevant images or video files, which provide an additional dimension to published articles and enhance understanding. As an open access journal, Cardiovascular Ultrasound ensures high visibility for authors in addition to providing an up-to-date and freely available resource for the community. The journal welcomes discussion, and provides a forum for publishing opinion and debate ranging from biology to engineering to clinical echocardiography, with both speed and versatility.