An alternative strategy for COVID-pneumonitis: a retrospective analysis from a tertiary center in Belgium

Abstract

At the start of the COVID-19 pandemic in Europe no clear guidelines on its treatment were available. While early intubation and the avoidance of steroids was proposed, an alternative strategy of noninvasive ventilation and steroid use in case of refractory hypoxemia after one week was implemented to decrease the burden on resources. This single center retrospective analysis assessed the feasibility and safety of such a strategy. All patients admitted to the ICU with a confirmed COVID-19 pneumonitis from March to June 2020 were included in the analysis. Multivariable logistic regression was done to assess (1) the feasibility of ICU mortality prediction by the Charlson Comorbidity Index and the Clinical Frailty Score (2) the impact of invasive mechanical ventilation and steroid administration in ICU mortality. 97 patients were admitted to the ICU. Mean APACHEIII was 67 (16), with a predicted ICU mortality of 30%. Median P/F ratio was 91 (IQR 67-118) on admission. Only 37 (40%) patients were intubated and mechanically ventilated within their ICU stay. The ICU mortality rate was 20.6% (n=20). The multivariable logistic regression model for ICU mortality, using gender, Charlson Comorbidity Index and Clinical Frailty Score had an AUROC of 0.81, with an R-2 of 0.23. Thirty eight patients (39%) of 97 patients received steroids. Adding steroid administration to the multivariable model did not yield the latter as an independent factor of ICU-mortality (p=0.06). However, mechanical ventilation remained an independent risk factor for ICU-mortality (p=0.004) with an odds ratio of 9.9 (95%CI 1.8-53.6), after adjustment for baseline risk factors Charlson Comorbidity Index, Clinical Frailty Score and APACHE-III score. This single center retrospective analysis demonstrated a safe alternative strategy using a non-invasive ventilation strategy and late administration of steroids. These findings need to be confirmed in multi-center prospective randomised controlled trials.