• Alberto Zanella, Gaetano Florio, Massimo Antonelli, Giacomo Bellani, Angela Berselli, Tiziana Bove, Luca Cabrini, Eleonora Carlesso, Gian Paolo Castelli, Maurizio Cecconi, Giuseppe Citerio, Irene Coloretti, Daniele Corti, Francesca Dalla Corte, Edoardo De Robertis, Giuseppe Foti, Roberto Fumagalli, Massimo Girardis, Riccardo Giudici, Lorenzo Guiotto, Thomas Langer, Lucia Mirabella, Daniela Pasero, Alessandro Protti, Marco V Ranieri, Roberto Rona, Luigia Scudeller, Paolo Severgnini, Savino Spadaro, Nino Stocchetti, Martina Viganò, Antonio Pesenti, Giacomo Grasselli, and COVID-19 Italian ICU Network.
• Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
• Intensive Care Med. 2021 Sep 1; 47 (9): 995-1008.

PurposeTo evaluate the daily values and trends over time of relevant clinical, ventilatory and laboratory parameters during the intensive care unit (ICU) stay and their association with outcome in critically ill patients with coronavirus disease 19 (COVID-19).MethodsIn this retrospective-prospective multicentric study, we enrolled COVID-19 patients admitted to Italian ICUs from February 22 to May 31, 2020. Clinical data were daily recorded. The time course of 18 clinical parameters was evaluated by a polynomial maximum likelihood multilevel linear regression model, while a full joint modeling was fit to study the association with ICU outcome.Results1260 consecutive critically ill patients with COVID-19 admitted in 24 ICUs were enrolled. 78% were male with a median age of 63 [55-69] years. At ICU admission, the median ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) was 122 [89-175] mmHg. 79% of patients underwent invasive mechanical ventilation. The overall mortality was 34%. Both the daily values and trends of respiratory system compliance, PaO2/FiO2, driving pressure, arterial carbon dioxide partial pressure, creatinine, C-reactive protein, ferritin, neutrophil, neutrophil-lymphocyte ratio, and platelets were associated with survival, while for lactate, pH, bilirubin, lymphocyte, and urea only the daily values were associated with survival. The trends of PaO2/FiO2, respiratory system compliance, driving pressure, creatinine, ferritin, and C-reactive protein showed a higher association with survival compared to the daily values.ConclusionDaily values or trends over time of parameters associated with acute organ dysfunction, acid-base derangement, coagulation impairment, or systemic inflammation were associated with patient survival.© 2021. The Author(s).

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