Multistate Modeling of COVID-19 Patients Using a Large Multicentric Prospective Cohort of Critically Ill Patients

The mortality of COVID-19 patients in the intensive care unit (ICU) is influenced by their state at admission. We aimed to model COVID-19 acute respiratory distress syndrome state transitions from ICU admission to day 60 outcome and to evaluate possible prognostic factors. We analyzed a prospective French database that includes critically ill COVID-19 patients. A six-state multistate model was built and 17 transitions were analyzed either using a non-parametric approach or a Cox proportional hazard model. Corticosteroids and IL-antagonists (tocilizumab and anakinra) effects were evaluated using G-computation. We included 382 patients in the analysis: 243 patients were admitted to the ICU with non-invasive ventilation, 116 with invasive mechanical ventilation, and 23 with extracorporeal membrane oxygenation. The predicted 60-day mortality was 25.9% (95% CI: 21.8%-30.0%), 44.7% (95% CI: 48.8%-50.6%), and 59.2% (95% CI: 49.4%-69.0%) for a patient admitted in these three states, respectively. Corticosteroids decreased the risk of being invasively ventilated (hazard ratio (HR) 0.59, 95% CI: 0.39-0.90) and IL-antagonists increased the probability of being successfully extubated (HR 1.8, 95% CI: 1.02-3.17). Antiviral drugs did not impact any transition. In conclusion, we observed that the day-60 outcome in COVID-19 patients is highly dependent on the first ventilation state upon ICU admission. Moreover, we illustrated that corticosteroid and IL-antagonists may influence the intubation duration.

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Electronic Article

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Journal of clinical medicine - Vol. 10, No. 3 (2021)




Ursino, Moreno
Dupuis, Claire
Buetti, Niccolò
de Montmollin, Etienne
Bouadma, Lila
Golgran-Toledano, Dany
Ruckly, Stéphane
Neuville, Mathilde
Cohen, Yves
Mourvillier, Bruno
Souweine, Bertrand
Gainnier, Marc
Laurent, Virginie
Terzi, Nicolas
Shiami, Shidasp
Reignier, Jean
Alberti, Corinne
Timsit, Jean-François
On Behalf Of The Outcomerea Study Group




Acute respiratory distress disease
Intensive unit care
Journal Article


Date Revised 10.02.2021

published: Electronic

Citation Status PubMed-not-MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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