Determinants of Limiting Life-Sustaining Treatment in Critically Ill COVID-19 Patients: A Multicenter Study in Korean Intensive Care Units.

IF 3 Q2 RESPIRATORY SYSTEM

Tuberculosis and Respiratory Diseases Pub Date : 2025-07-01 Epub Date: 2025-04-28 DOI:10.4046/trd.2024.0137

I Re Heo, Tae Hoon Kim, Won Jai Jung, Gil Myeong Seong, Sun Jung Kwon, Jae Young Moon, Song-I Lee, Do Sik Moon, Tae-Ok Kim, Chul Park, Eun Young Choi, Jung-Wan Yoo, Sunghoon Park, Ae Rin Baek, Sung Yoon Lim, Jung Soo Kim, Jongmin Lee, Chi Ryang Chung, Sang-Min Lee, Su Hwan Lee, Moon Seong Baek, Jin Won Huh, Woo Hyun Cho, Ho Cheol Kim

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Abstract

Background: Understanding of the life-sustaining treatment (LST) decisions in critically ill coronavirus disease 2019 (COVID-19) patients remains limited. This study aimed to identify factors influencing LST decisions, and compare clinical outcomes between patients with, and without, LST.

Methods: This multicenter, retrospective cohort study analyzed data from 1,081 COVID-19 patients admitted to intensive care units (ICUs) across Korea from January 1, 2020, to August 31, 2021. Patients were divided into LST and non-LST groups. Demographic, clinical, and outcome data were collected and compared.

Results: Of 1,081 patients, 207 (19.2 %) received LST. LST patients were older (median age: 76 years vs. 67 years, p<0.001), and had more comorbidities (85.5% vs. 70.4%, p<0.001), especially cardiovascular and chronic lung disease. They showed higher blood urea nitrogen, lower albumin, and elevated D-dimer levels (all p<0.05). ICU interventions, including mechanical ventilation (82.6% vs. 50.9%, p<0.001) and extracorporeal membrane oxygenation (ECMO) (18.8% vs. 9.8%, p<0.001), were more common. ICU and hospital mortality rates were significantly higher in LST patients (82.6% and 94.2%, respectively, p<0.001). Logistic regression identified age (odds ratio [OR], 1.054 per year; p<0.001), mechanical ventilation (OR, 2.789; p=0.002), and ECMO use (OR, 3.580; p=0.002) as independent predictors of LST.

Conclusion: Age, comorbidities, and ICU interventions significantly influence LST decisions, highlighting the need for ethical and evidence-based critical care guidelines.

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限制COVID-19危重患者维持生命治疗的决定因素：韩国icu的多中心研究

背景：对COVID-19危重患者维持生命治疗（LST）决策的了解仍然有限。本研究旨在确定影响LST决定的因素，并比较LST患者和非LST患者的临床结果。方法：本多中心回顾性队列研究分析了2020年1月1日至2021年8月31日全国1081例新冠肺炎icu患者的数据。患者分为LST组和非LST组。收集并比较人口学、临床和结局数据。结果：1081例患者中，207例（19.2%）接受了LST治疗。LST患者年龄较大（中位年龄：76岁对67岁，p < 0.001），合并症较多（85.5%对70.4%,p < 0.001），特别是心血管和慢性肺部疾病。BUN升高，白蛋白降低，d -二聚体升高（p < 0.05）。ICU干预更常见，包括机械通气（82.6% vs. 50.9%, p < 0.001）和ECMO （18.8% vs. 9.8%, p < 0.001）。LST患者的ICU死亡率和住院死亡率均显著高于LST患者（分别为82.6%和94.2%,p < 0.001）。Logistic回归发现年龄（OR = 1.054 /年，p < 0.001）、机械通气（OR = 2.789, p = 0.002）和ECMO使用（OR = 3.580, p = 0.002）是LST的独立预测因子。结论：年龄、合并症和ICU干预措施显著影响LST的决定，强调了道德和循证重症监护指南的必要性。

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