Multistate Modeling of COVID-19 Patients Using a Large Multicentric Prospective Cohort of Critically Ill Patients - Sorbonne Université
Journal Articles Journal of Clinical Medicine Year : 2021

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

Moreno Ursino
Mathilde Neuville
Shidasp Shiami
  • Function : Author

Abstract

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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Dates and versions

hal-03134612 , version 1 (08-02-2021)

Identifiers

Cite

Moreno Ursino, Claire Dupuis, Niccolò Buetti, Etienne de Montmollin, Lila Bouadma, et al.. Multistate Modeling of COVID-19 Patients Using a Large Multicentric Prospective Cohort of Critically Ill Patients. Journal of Clinical Medicine, 2021, 10 (3), pp.544. ⟨10.3390/jcm10030544⟩. ⟨hal-03134612⟩
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