Outcomes and Predictors of Mortality in Patients with Severe COVID-19 and COPD admitted to ICU: A multicenter study

Abstract

Background: High mortality rates among patients with chronic obstructive pulmonary disease (COPD) admitted to intensive care units (ICUs) during the COVID-19 pandemic highlight the need for tailored clinical management strategies.

Study design and methods: Epidemiological, clinical, and laboratory data were collected in REDCap for 6,512 patients hospitalized with COVID-19 across 55 Spanish ICUs. Patients were stratified into three groups: those with COPD, those with other chronic respiratory diseases (CRD), and those without respiratory comorbidities (No CRD). The primary outcome was to determine clinical predictors for 90-day mortality, focusing on the COPD group. A propensity score matching (PSM) method was applied to analyze the effects of respiratory support, biomarkers, and immunomarkers.

Results: Patients with COPD (n = 328) exhibited a 50% mortality rate compared to 33% of those with other chronic respiratory diseases (CRD, n = 547), and those without respiratory comorbidities (No CRD, n = 5,124). Among COPD patients, 95% of whom had Acute Respiratory Distress Syndrome (ARDS) due to COVID-19, the use of a high-flow nasal cannula (HFNC) was associated with reduced 90-day mortality (hazard ratio: 0.54 (95% Confidence Interval [0.31 to 0.95]). At a molecular scale, lower IgG levels but higher viral load and TNF-alpha, Vascular Cell Adhesion Molecule-1 (VCAM-1), and Fas Cell Surface Death Receptor (Fas) were associated with mortality in the COPD group.

Conclusions: In COPD patients with ARDS due to COVID-19, the use of HFNC was associated with a better prognosis. The dysregulation in biomarkers and immunomarkers in COPD patients and its association with mortality highlight the need for further targeted therapeutic strategies.

Keywords: Acute respiratory distress syndrome; Biomarkers; Chronic Obstructive pulmonary disease; High flow nasal cannulas; Respiratory support.