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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Demographic, clinical, and outcome data were collected and compared.</p><p><strong>Results: </strong>Of 1,081 patients, 207 (19.2%) received LST. LST patients were older (median age: 76 vs. 67 years, p < 0.001) and had more comorbidities (85.5% vs. 70.4%, p < 0.001), particularly cardiovascular and chronic lung disease. They had higher BUN, 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 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 (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.</p><p><strong>Conclusion: </strong>Age, comorbidities, and ICU interventions significantly influence LST decisions, highlighting the need for ethical and evidence-based critical care guidelines.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Determinants of Limiting Life-Sustaining Treatment in Critically Ill COVID-19 Patients: A Multicenter Study in Korean ICUs.\",\"authors\":\"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\",\"doi\":\"10.4046/trd.2024.0137\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Understanding life-sustaining treatment (LST) decisions in critically ill COVID-19 patients remains limited. 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ICU and hospital mortality rates were significantly higher in LST patients (82.6% and 94.2%, respectively, p < 0.001). Logistic regression identified age (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.</p><p><strong>Conclusion: </strong>Age, comorbidities, and ICU interventions significantly influence LST decisions, highlighting the need for ethical and evidence-based critical care guidelines.</p>\",\"PeriodicalId\":23368,\"journal\":{\"name\":\"Tuberculosis and Respiratory Diseases\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-04-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Tuberculosis and Respiratory Diseases\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4046/trd.2024.0137\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Tuberculosis and Respiratory Diseases","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4046/trd.2024.0137","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
摘要
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。
Determinants of Limiting Life-Sustaining Treatment in Critically Ill COVID-19 Patients: A Multicenter Study in Korean ICUs.
Background: Understanding life-sustaining treatment (LST) decisions in critically ill 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 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 vs. 67 years, p < 0.001) and had more comorbidities (85.5% vs. 70.4%, p < 0.001), particularly cardiovascular and chronic lung disease. They had higher BUN, 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 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 (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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