Comparison of the clinical characteristics and mortality in ARDS due to COVID-19 versus ARDS due to Influenza A-H1N1pdm09
Preprint
- 25 February 2021
- preprint
- Published by Cold Spring Harbor Laboratory
Abstract
Importance: Infection with the SARS-Cov-2 and Influenza A-H1N1 viruses is responsible for the first pandemics of the 21st century. Both of these viruses can cause severe pneumonia and acute respiratory distress syndrome (ARDS). The clinical differences and mortality associated with these two pandemic pneumonias in patients with ARDS are not well establishedObjective: To compare case-fatality between ARDS-Covid-19 and ARDS-Influenza A (H1N1), adjusting for known prognostic risk factors.Design, Setting and Participants: One hundred forty-seven patients with COVID-19 were compared with 94 with Influenza A-H1N1, all of these were admitted to the intensive care unit of the Referral Center for Respiratory Diseases and COVID-19 in Mexico City and fulfilled the criteria of ARDS.Results: Patients arrived at the hospital after 9 days of symptoms. Influenza patients had more obesity, more use of Norepinephrine, and higher levels of lactic dehydrogenase and glucose, and fewer platelets and lower PaO2/FIO2. Crude mortality was higher in COVID than in influenza (39% vs. 22%; p = 0.005). In a Cox proportional hazard model, patients with a diagnosis of COVID-19 had a hazard ratio (HR) = 3.7; 95% Confidence Interval [CI] = 1.9-7.4, adjusted for age, gender, sequential organ failure assessment (SOFA) score, ventilatory ratio, and prone ventilation. In the fully adjusted model, the ventilatory ratio and the absence of prone-position ventilation were also predictors of mortality.CONCLUSION: COVID-19 patients treated in an intensive care unit (ICU) had a 3.7 times higher risk of death than similar patients with Influenza A-H1N1, after adjusting for SOFA score and other relevant risk factors for mortality.Question: Is the mortality of ARDS associated with Covid-19 greater than that of ARDS associated to influenza H1N1?Findings: In a Cox proportional hazard model, patients with a diagnosis of COVID-19 had a hazard ratio (HR) = 3.7; 95% Confidence Interval [CI] = 1.9-7.4, adjusted for age, gender, sequential organ failure assessment (SOFA) score.Meaning: COVID-19 patients treated in an intensive care unit (ICU) had a 3.7 times higher risk of death than similar patients with Influenza A-H1N1Keywords
This publication has 10 references indexed in Scilit:
- Distinct inflammatory profiles distinguish COVID-19 from influenza with limited contributions from cytokine stormScience Advances, 2020
- Vascular neutrophilic inflammation and immunothrombosis distinguish severe COVID‐19 from influenza pneumoniaJournal of Thrombosis and Haemostasis, 2020
- Cytokine Levels in Critically Ill Patients With COVID-19 and Other ConditionsJAMA, 2020
- A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family clusterThe Lancet, 2020
- Global mortality associated with seasonal influenza epidemics: New burden estimates and predictors from the GLaMOR ProjectJournal of Global Health, 2019
- Physiologic Analysis and Clinical Performance of the Ventilatory Ratio in Acute Respiratory Distress SyndromeAmerican Journal of Respiratory and Critical Care Medicine, 2019
- Global Variability in Reported Mortality for Critical Illness during the 2009-10 Influenza A(H1N1) Pandemic: A Systematic Review and Meta-Regression to Guide Reporting of Outcomes during Disease OutbreaksPLOS ONE, 2016
- Acute Respiratory Distress SyndromeJAMA, 2012
- Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in MexicoThe New England Journal of Medicine, 2009
- The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failureIntensive Care Medicine, 1996