Journal
ANNALS OF THE AMERICAN THORACIC SOCIETY
Volume 18, Issue 7, Pages 1202-1210Publisher
AMER THORACIC SOC
DOI: 10.1513/AnnalsATS.202008-1026OC
Keywords
pneumonia; acute respiratory distress syndrome; SARS-CoV-2; COVID-19
Categories
Funding
- U.S. Department of Veterans Affairs Biomedical Laboratory RD Service [IK2 BX004886]
- National Heart, Lung, and Blood Institute of the National Institutes of Health [K23 HL129987, K23GM122069, P01HL114453, R01 HL136143, R01 HL142084, K24 HL143285]
- University of Pittsburgh Clinical and Translational Science Institute COVID-19 Pilot Grant Program
- University of Pittsburgh Medical Center Immune Therapy and Transplant Center
- University of Pittsburgh Medical Center
- Hillman Postdoctoral Fellowship for Innovative Cancer Research
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COVID-19 ARDS and ARDS from other etiologies have differences in demographic, physiologic parameters, and clinical outcomes, such as IL-6 levels and minute ventilation. Despite some similarities, COVID-19 ARDS shows longer duration of mechanical ventilation compared to other ARDS patients.
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 5 14), bacterial ARDS (n 5 21), and ARDS due to culturenegative pneumonia (n 5 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 culturenegative 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.
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