Table 1.
Characteristics, presentation and outcome of ventilated patients with COVID-19 and flu-related ARDS
| COVID-19 (n = 18) | Flu (n = 23) | p value | |
|---|---|---|---|
| Patients’ characteristics | |||
| Age, years | 70 (57–75) | 58 (49–64) | 0.006 |
| Male (%) | 12 (67) | 12 (52) | 0.524 |
| BMI, kg/m2 | 29 (26–32) | 29 (25–34) | 0.519 |
| Hypertension (%) | 11 (61) | 10 (43) | 0.350 |
| Diabetes mellitus (%) | 4 (22) | 3 (13) | 0.679 |
| Time from illness onset to ICU admission, days | 11 (7–13) | 5 (4–10) | 0.017 |
| Time from illness onset to intubation, days | 12 (8–15) | 6 (4–10) | 0.002 |
| Time from illness onset to echocardiography, days | 14 (9–17) | 13 (6–17) | 0.001 |
| SAPS II | 34 (30–38) | 43 (32–54) | 0.015 |
| SOFA score | 4 (2–4) | 6 (4–9) | < 0.001 |
| Clinical presentation and treatment | |||
| ECG changes* (%) | 1 (5%) | 3 (13%) | 0.618 |
| Documented coinfection (%) | 3 (17) | 9 (39) | 0.171 |
| Septic shock (%) | 0 (%) | 10 (43) | – |
| Vasopressor support (%) | 2 (11) | 10 (43) | 0.038 |
| Prone position (%) | 10 (56) | 14 (61) | 1.000 |
| Neuromuscular blockers (%) | 17 (94%) | 12 (52%) | 0.005 |
| Biology on admission | |||
| Troponin I (ng/L) | 73 (51–94) | 53 (37–66) | 0.020 |
| Lactate, mmol/L | 1.17 (0.89–1.57) | 1.51 (1.02–2.54) | 0.143 |
| Creatinine, μmol/L | 58 (42–87) | 88 (59–160) | 0.021 |
| Prothombine time, % | 87 (78–96) | 87 (71–101) | 0.979 |
| AST, U/L | 55 (27–71) | 107 (46–203) | 0.020 |
| ALT, U/L | 37 (27–65) | 45 (27–115) | 0.527 |
| CPK, U/L | 72 (34–103) | 419 (180–2456) | < 0.001 |
| White blood cell count, G/L | 7.98 (6.61–11.25) | 5.96 (4.02–8.05) | 0.003 |
| Lymphocyte count, G/L | 0,78 (0.55–1.05) | 0.75 (0.47–1.13) | 0.770 |
| Eosinophils count, G/L | 0.02 (0.02–0.09) | 0.01 (0.00–0.01) | 0.094 |
| Platelet count, G/L | 318 (218–425) | 172 (153–225) | < 0.001 |
| Hemoglobin, g/dl | 11.2 (10.2–12.3) | 13.1 (11.6–14.2) | 0.007 |
| Respiratory parameters | |||
| PaO2/FiO2 | 130 (81–217) | 70 (62–100) | < 0.001 |
| Arterial pH | 7.35 (7.29–7.45) | 7.32 (7.23–7.41) | 0.121 |
| PaCO2, mmHg | 44 (33–51) | 47 (36–60) | 0.430 |
| RR, breaths/min | 24 (22–27) | 25 (24–28) | 0.139 |
| Tidal volume, mL/kg | 5.2 (4.5–6.2) | 5.3 (4.0–6.1) | 0.885 |
| PEEP, cmH2O | 10 (8–12) | 10 (8–12) | 0.476 |
| Plateau pressure, cmH2O | 23 (20–26) | 28 (20–28) | 0.144 |
| Driving pressure, cmH2O | 12 (10–15) | 18 (17–18) | 0.001 |
| Respiratory-system compliance**, mL/cmH2O | 38 (31–45) | 23 (22–27) | 0.001 |
| Hemodynamic parameters | |||
| Heart rate, bpm | 90 (72–109) | 105 (69–118) | 0.494 |
| Mean arterial blood pressure, mmHg | 102 (85–110) | 78 (71–94) | < 0.001 |
| CVP, mmHg | 9 (7–10) | 11 (9–14) | 0.058 |
| Cardiovascular phenotypes | |||
| ACP (%) | 3 (17) | 11 (48) | 0.051 |
| Severe ACP (%) | 1 (5) | 8 (35) | 0.054 |
| LV failure | 3*** (17) | 14 (61) | 0.009 |
| Hypovolemia | 2 (11) | 1 (4) | 0.573 |
| Hyperkinesia | 6 (33) | 7 (30) | 1.00 |
| Normal hemodynamic profile | 8 (44) | 5 (22) | 0.179 |
| Echocardiographic indices | |||
| Cardiac index**** (L/min/m2) | 3.1 (2.5–4.2) | 2.5 (2.0–3.0) | 0.034 |
| RVEDA/LVEDA | 0.55 (0.37–0.60) | 0.70 (0.54–0.80) | 0.021 |
| RVFAC, % | 46 (35–50) | 33 (24–39) | 0.002 |
| TAPSE, mm | 25 (23–29) | 18 (16–22) | < 0.001 |
| Tricuspid S′, cm/s | 16.0 (15.0–20.5) | 12.2 (11.0–13.4) | 0.005 |
| TR peak velocity, m/s | 3.2 (2.9–3.6) | 2.9 (2.4–3.2) | 0.113 |
| IVC diameter, mm | 22 (19–26) | 22 (21–24) | 0.762 |
| LVEF (%) | 52 (44–61) | 44 (28–59) | 0.265 |
| LVOT VTI, cm | 22 (18–25) | 18 (13–24) | 0.106 |
| Mitral E/E′ ratio | 7.3 (6.5–10.9) | 7.8 (6.1–10.6) | 0.730 |
| Outcome | |||
| ICU mortality***** (%) | 1 (6) | 9 (39) | 0.025 |
Abbreviations: BMI body mass index, SAPSII Simplified Acute Physiology Score, SOFA Sepsis Organ Failure Assessment, AST aspartate aminotransferase, ALT alanine aminotransferase, CPK creatinine phosphokinase, RR respiratory rate, PEEP positive end-expiratory pressure, CVP central venous pressure, ACP acute cor pulmonale, LV left ventricle, RVEDA right ventricular end-diastolic area, LVEDA left ventricular end-diastolic area, RVFAC right ventricular fractional area change, TAPSE tricuspid annular plane systolic excursion, TR tricuspid regurgitation, IVC inferior vena cava, LVEF left ventricular ejection fraction, LVOT left ventricular outflow tract, VTI velocity-time integral, ICU intensive care unit
*One patient had anterior negative T-wave in the COVID-19 group; 2 patients had inferior negative T-wave, and 1 patient had anterior negative T-wave in the flu group [2]
**Calculated as the tidal volume divided by the driving pressure (difference between the inspiratory plateau pressure and positive end-expiratory pressure)
***One patient was diagnosed with a Tako-tsubo syndrome during transesophageal echocardiography examination performed shortly after tracheal intubation, after 6 days of high-flow nasal cannula; full recovery of left ventricular systolic function was documented under mechanical ventilation 10 days later
****Measured using the Doppler method applied at the left ventricular outflow tract
*****As per April 24, with still 6 patients hospitalized in the intensive care unit, 5 of them being invasively ventilated