Table 1.
Baseline characteristics, treatments and outcomes of ICU patients with severe COVID-19 pneumonia
| All patients (n = 549) | Spontaneous pneumomediastinum (n = 21) | No Spontaneous pneumomediastinum (n = 528) | P Value | |
|---|---|---|---|---|
| Age (year) | 64 [56–71] | 62[54–70] | 64[56–71] | 0.34 |
| Sex male | 377 (68.7) | 15 (71.4) | 362 (68.6) | 0.78 |
| Current smoking | 23 (4.2) | 0 | 23 (4.4) | 0.99* |
| Former smoker | 185 (33.7) | 6 (28.6) | 179 (33.9) | 0.61* |
| Body-mass index (kg/m2) | 28.7 [25.3–32.7] | 27.6 [25.2–28.7] | 28.8 [25.4–32.8] | 0.023 |
| Comorbid conditions | ||||
| Arterial hypertension | 308 (56.1) | 13 (61.9) | 295 (55.9) | 0.59 |
| Diabetes | 190 (34.6) | 6 (28.6) | 184 (34.8) | 0.55 |
| COPD | 38 (6.9) | 0 | 38 (7.2) | 0.39* |
| Asthma | 33 (6.0) | 2 (9.5) | 31 (5.9) | 0.36* |
| Obstructive sleep apnea | 63 (11.5) | 0 | 63 (11.9) | 0.15* |
| Interstitial lung disease | 12 (2.2) | 0 | 12 (2.3) | 0.99* |
| Medication before ICU admission | ||||
| Corticosteroidsa | 350 (63.8) | 13 (61.9) | 337 (63.8) | 0.86 |
| Tocilizumab | 20 (3.6) | 0 | 20 (3.8) | 0.99* |
| Time between symptoms onset and ICU admission (days) | 9 [7–11] | 9 [7–11] | 9 [7–11] | 0.71 |
| Time between ward admission and ICU referral (days) | 1 [0–3] | 1 [0–3] | 1 [0–3] | 0.65 |
| SAPSII score | 31 [24–38] | 31 [26–39] | 31 [24–38] | 0.57 |
| Biological parameters, day 1 | ||||
| WBC, G/L | 8.3 [6.1–11.3] | 7.2 [5–11.5] | 8.3 [6.2–11.3] | 0.37 |
| Neutrophil, G/L | 7.1 [4.9–9.6] | 6.8 [4.4–9.9] | 7.1 [5–9.6] | 0.70 |
| Lymphocyte, G/L | 0.7 [0.5–1] | 0.6[0.4–1.0] | 0.7 [0.5–1] | 0.29 |
| Platelet, G/L | 234 [172–300] | 221 [172–285] | 235 [172–300] | 0.53 |
| D-dimers, ng/mL | 1380 [823–2530] | 1425 [986–1886] | 1368 [821–2570] | 0.84 |
| CRP, mg/L | 120 [70–188] | 121 [53–175] | 120 [70–189] | 0.77 |
| LDH, IU/L | 546 [415–738] | 787 [682–984] | 538 [415–731] | 0.04 |
| Creatinine, µmol/L | 71 [57–92] | 67 [59–79] | 71 [56–93] | 0.59 |
| Blood Gas, day 1 | ||||
| pH | 7.46 [7.44–7.49] | 7.48 [7.46–7.51] | 7.46 [7.44–7.49] | 0.11 |
| PaO2/FIO2 (mmHg) | 105 [72–153] | 112 [96–158] | 103 [72–153] | 0.60 |
| PaCO2 (mmHg) | 34 [31–38] | 32 [30–35] | 34 [31–38] | 0.04 |
| Baseline chest CT-scanb | ||||
| Extent of lung damage > 50% | 213 (46.1) | 11 (64.7) | 202 (45.4) | 0.12 |
| Emphysema | 45 (9.7) | 3 (17.6) | 42 (9.4) | 0.22 |
| Pulmonary embolism | 23 (5.6) | 0 | 23 (5.8) | 0.99* |
| Bronchiectasis/cyst | 18 (3.9) | 1 (5.9) | 17 (3.8) | 0.50* |
| Immunomodulatory treatment during ICU stay | ||||
| Corticosteroids | 538 (98) | 21 (100) | 517 (97.9) | 0.99* |
| Additional corticosteroid pulses | 72 (13.1) | 9 (42.9) | 63 (11.9) | 0.0006* |
| Time between ICU admission and corticosteroid pulses | 9 [4–18] | 12 [6–17] | 9 [4–18] | 0.66 |
| Dose of corticosteroid pulses (mg/kg)c | 2.7 [2–3.4] | 3 [2.5–3.2] | 2.7 [1.9–3.4] | 0.58 |
| Tocilizumab | 16 (2.9) | 0 | 16 (3) | 0.99* |
| Organ support during ICU stay | ||||
| Awake prone positioning | 139 (25.6) | 12 (60) | 127 (24.3) | 0.0003 |
| Noninvasive ventilation support | ||||
| HFNO | 497 (90.5) | 21 (100) | 476 (90.2) | 0.25* |
| Additional NIV to HFNO | 161 (29.3) | 11 (52.4) | 150 (28.4) | 0.02* |
| Invasive Mechanical Ventilation | 249 (45.4) | 11 (52.4) | 238 (45.1) | 0.51 |
| Time between ICU admission and IMV, (days) | 2 [1–5] | 6 [5–13] | 2 [1–4] | 0.00002 |
| Tracheostomy | 44 (8) | 2 (9.5) | 42 (8) | 0.68* |
| Vasopressor supports | 177 (32.2) | 11 (52.4) | 166 (31.4) | 0.04 |
| ECMO | 18 (3.3) | 2 (9.5) | 16 (3) | 0.15* |
| Renal replacement therapy | 62 (11.3) | 3 (14.3) | 59 (11.1) | 0.72* |
| Outcomes | ||||
| Death in ICU | 153 (27.9) | 7 (33.3) | 146 (27.7) | 0.57 |
| ICU length of stay (days) | 10 [5–21] | 18 [14–25] | 9 [5–21] | 0.008 |
| Hospital length of stay (days) | 19 [13–32] | 27 [22–35] | 18 [12–32] | 0.01 |
Data are presented as median [first through third quartiles] or number (%). Continuous variables are compared using a Wilcoxon method; categorical variables are compared either using a χ2 test or Fisher’s exact test when followed by (*)
IMV Invasive mechanical ventilation; WBC White blood cell; CRP C-reactive protein; LDH lactate dehydrogenase; CPK Creatine phosphokinase; ICU Intensive care unit; ECMO Extracorporeal membrane oxygenation
aInitial corticosteroid therapy was either dexamethasone 6 mg or Hydrocortisone 200 mg per day
bBaseline CT scan was performed in 17 (80.9%) patients in SP group and 446 (84.6%) patients in control group (P = 0.65)
cCorticosteroid pulses dose in methylprednisolone equivalent