LAUSR

Objectives To investigate risk factors for non-invasive/invasive-ventilatory support (NI/I-VS) in Coronavirus diseases 2019 (COVID-19) patients. Methods All consecutive patients admitted, from February 25 to April 25, 2020, to the Infectious Diseases Unit and Intensive Care Unit of Santa Maria Annunziata Hospital (Florence, Italy) with confirmed COVID-19 diagnosis were enrolled in this retrospective cohort study. NI/I-VS was defined as need for continuous positive airway pressure (CPAP) or bilevel positive pressure non-invasive ventilation (BPAP) or mechanical ventilation (MV) than low-flow systems oxygen-therapy as Venturi Mask (VM) or nasal cannula. Results Ninety-seven patients were enrolled; 61,9% (60/97) were male, median age was 64 years; intra-hospital mortality was 9.3%. Thirty five out of 97 (36%) patients required ICU admission and 94.8% (92/97) were prescribed oxygen-therapy: 10.8% (10/92) with nasal cannula, 44.5% (41/92) with VM, 31.5% (29/92) with CPAP, 2.2% (2/92) with BPAP and 10.8% (10/92) underwent intubation for MV. Patients with body mass index >30, type II diabetes mellitus and presenting at the admission with dyspnoea, asthenia, SOFA score ≥2 points, PaO2/FiO2 < 300, temperature >38 °C, increased levels of lactate dehydrogenase (LDH), alanine aminotransferase, C-reactive protein and a d-dimer >1000 ng/ml underwent more frequently NI/I-VS at the univariate analysis. Multivariate logistic regression analysis confirmed temperature >38 °C (odds ratio [OR] 21.2, 95% confidential interval [95%CI] 3.5-124.5, p = 0.001), LDH > 250 U/L (OR 15.2, 95%CI 1.8-128.8, p = 0.012) and d-dimer >1000 ng/ml (OR 4.5, 95%CI 1.2-17.3, p = 0.027) as significantly associated with NI/I-VS requirement. A non-significant trend (p = 0.051) was described for PaO2/FiO2 < 300. Conclusions Temperature >38 °C, LDH > 250 U/L and d-dimer >1000 ng/ml resulted to be indipendent risk factors for NI/I-VS in COVID-19 patients. In order to quickly recognize patients likely at risk to develop a critical illness, inflammatory markers assessment should be warranted upon hospital admission.