Characterisation and outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: a single-centre experience
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...
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doaj-1245921ab560495d92e1a18f354b6d732021-02-01T14:31:28ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392020-05-017110.1136/bmjresp-2020-000731Characterisation and outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: a single-centre experienceRahul Y Mahida0Dhruv Parekh1David R Thickett2Marina Soltan3Mansoor Bangash4Jaimin Patel5Minesh Chotalia6Joseph Alderman7Chhaya Patel8Amber Hayden9Ruchi Desai10Emily Beesley11Louise E Crowley12Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UKBirmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UKBirmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UKBirmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UKBirmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UKDepartment of Critical Care and Anaesthesia, Queen Elizabeth Hospital Birmingham, Birmingham, UKBirmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UKBirmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UKSchool of Medical Sciences, The University of Manchester, Manchester, Manchester, UKSchool of Medical and Dental Sciences, University of Birmingham, Birmingham, Birmingham, UKSchool of Medical and Dental Sciences, University of Birmingham, Birmingham, Birmingham, UKSchool of Medical and Dental Sciences, University of Birmingham, Birmingham, Birmingham, UKBirmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UKIntroduction 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.https://bmjopenrespres.bmj.com/content/7/1/e000731.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Rahul Y Mahida Dhruv Parekh David R Thickett Marina Soltan Mansoor Bangash Jaimin Patel Minesh Chotalia Joseph Alderman Chhaya Patel Amber Hayden Ruchi Desai Emily Beesley Louise E Crowley |
spellingShingle |
Rahul Y Mahida Dhruv Parekh David R Thickett Marina Soltan Mansoor Bangash Jaimin Patel Minesh Chotalia Joseph Alderman Chhaya Patel Amber Hayden Ruchi Desai Emily Beesley Louise E Crowley Characterisation and outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: a single-centre experience BMJ Open Respiratory Research |
author_facet |
Rahul Y Mahida Dhruv Parekh David R Thickett Marina Soltan Mansoor Bangash Jaimin Patel Minesh Chotalia Joseph Alderman Chhaya Patel Amber Hayden Ruchi Desai Emily Beesley Louise E Crowley |
author_sort |
Rahul Y Mahida |
title |
Characterisation and outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: a single-centre experience |
title_short |
Characterisation and outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: a single-centre experience |
title_full |
Characterisation and outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: a single-centre experience |
title_fullStr |
Characterisation and outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: a single-centre experience |
title_full_unstemmed |
Characterisation and outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: a single-centre experience |
title_sort |
characterisation and outcomes of ards secondary to pneumonia in patients with and without sars-cov-2: a single-centre experience |
publisher |
BMJ Publishing Group |
series |
BMJ Open Respiratory Research |
issn |
2052-4439 |
publishDate |
2020-05-01 |
description |
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. |
url |
https://bmjopenrespres.bmj.com/content/7/1/e000731.full |
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