Characterisation and outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: a single-centre experience

Rahul Y Mahida, Minesh Chotalia, Joseph Alderman, Chhaya Patel, Amber Hayden, Ruchi Desai, Emily Beesley, Louise E Crowley, Marina Soltan, Mansoor Bangash, Dhruv Parekh, Jaimin Patel, David R Thickett

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Abstract

INTRODUCTION: Acute respiratory distress syndrome (ARDS) is the major cause of mortality in patients with SARS-CoV-2 pneumonia. It appears that development of 'cytokine storm' in patients with SARS-CoV-2 pneumonia precipitates progression to ARDS. However, severity scores on admission do not predict severity or mortality in patients with SARS-CoV-2 pneumonia. Our objective was to determine whether patients with SARS-CoV-2 ARDS are clinically distinct, therefore requiring alternative management strategies, compared with other patients with ARDS. We report a single-centre retrospective study comparing the characteristics and outcomes of patients with ARDS with and without SARS-CoV-2.

METHODS: Two intensive care unit (ICU) cohorts of patients at the Queen Elizabeth Hospital Birmingham were analysed: SARS-CoV-2 patients admitted between 11 March and 21 April 2020 and all patients with community-acquired pneumonia (CAP) from bacterial or viral infection who developed ARDS between 1 January 2017 and 1 November 2019. All data were routinely collected on the hospital's electronic patient records.

RESULTS: A greater proportion of SARS-CoV-2 patients were from an Asian ethnic group (p=0.002). SARS-CoV-2 patients had lower circulating leucocytes, neutrophils and monocytes (p<0.0001), but higher CRP (p=0.016) on ICU admission. SARS-CoV-2 patients required a longer duration of mechanical ventilation (p=0.01), but had lower vasopressor requirements (p=0.016).

DISCUSSION: The clinical syndromes and respiratory mechanics of SARS-CoV-2 and CAP-ARDS are broadly similar. However, SARS-CoV-2 patients initially have a lower requirement for vasopressor support, fewer circulating leukocytes and require prolonged ventilation support. Further studies are required to determine whether the dysregulated inflammation observed in SARS-CoV-2 ARDS may contribute to the increased duration of respiratory failure.

Original languageEnglish
Article numbere000731
JournalBMJ Open Respiratory Research
Volume7
Issue number1
DOIs
Publication statusPublished - 30 Nov 2020

Keywords

  • C-Reactive Protein/metabolism
  • COVID-19/complications
  • Cohort Studies
  • Critical Care/methods
  • Ethnic Groups/statistics & numerical data
  • Female
  • Humans
  • Leukocytes/metabolism
  • Male
  • Middle Aged
  • Monocytes/metabolism
  • Neutrophils/metabolism
  • Patient Outcome Assessment
  • Respiration, Artificial/statistics & numerical data
  • Respiratory Distress Syndrome/blood
  • Respiratory Mechanics
  • Retrospective Studies
  • SARS-CoV-2
  • Time
  • United Kingdom
  • Vasoconstrictor Agents/therapeutic use

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