• Stefano Franchini, Francesca Mette, Giovanni Landoni, Eleonora Setti, Luca Ferrante, Barbara Calcaterra, Gaia Pagliula, Alessandra Barbieri, Dario Fontani, Giorgia Borio, Marta Citro, Federica Farolfi, Gloria Suma, Giacomo Monti, Sergio Colombo, Lorenzo Dagna, Patrizia Rovere-Querini, Francesco DE Cobelli, Antonella Castagna, Fabio Ciceri, Alberto Zangrillo, Moreno Tresoldi, Antonio Secchi, and Massimiliano Etteri.
• Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy - franchini.stefano@hsr.it.
• Panminerva Med. 2024 Mar 1; 66 (1): 273527-35.

BackgroundLung damage leading to gas-exchange deficit and sepsis leading to systemic hypoperfusion are well-known features of severe pneumonia. Although frequently described in COVID-19, their prognostic impact in COVID-19-related pneumonia versus COVID-19-unrelated pneumonia has never been compared. This study assesses fundamental gas-exchange and hemodynamic parameters and explores their prognostic impact in COVID-19 pneumonia and non-COVID-19 pneumonia.MethodsWe prospectively evaluated arterial pO2/FiO2, alveolar to arterial O2 gradient, shock index, and serum lactate in 126 COVID-19 pneumonia patients, aged 18-65, presenting to the emergency department with acute, non-hypercapnic respiratory failure. As a control group we identified 1:1 age-, sex-, and pO2/FiO2-matched COVID-19-urelated pneumonia patients. Univariate and multivariable predictors of 30-day survival were identified in both groups.ResultsCOVID-19 patients showed lower arterial serum lactate concentration (P<0.001) and shock index (P<0.001) values as compared to non-COVID-19 patients. While we did not observe differences in lactate concentration or in shock index values in deceased vs. surviving COVID-19 patients (P=0.7 and P=0.6, respectively), non-COVID-19 deceased patients showed significantly higher lactate and shock index than non-COVID-19 survivors (P<0.001 and P=0.03). The pO2/FiO2 was the most powerful determinant of survival by Cox regression multivariate analysis in COVID-19 patients (P=0.006), while it was lactate in non-COVID-19 patients (P=0.001).ConclusionsAs compared to COVID19-unrelated pneumonia, COVID-19 pneumonia outcome seems more strictly correlated to the extent of lung damage, rather than to the systemic circulatory and metabolic derangements typical of sepsis.

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