.jpg "Carla Rosenzvit, MD, photo")
Peter Nauka, MD
Resident Physician
Montefiore Medical Center, United States
Disclosure information not submitted.
.jpg "Michelle Gong, MD, MS photo")
Michelle Gong, MD, MS
Chief of Critical Care Medicine
Montefiore Medical Center
New York, NY
Disclosure information not submitted.
Tina Chen, MD
Physician
Albert Einstein College of Medicine
Bronx, United States
Disclosure information not submitted.
Title: Comparison of Acute Respiratory Failure Between SARS-CoV-2 and Influenza
Introduction: We compared characteristics and outcomes between patients with acute respiratory failure (ARF) from Influenza and SARS-CoV-2 admitted to the ICU.
Methods: This was a retrospective cohort study using electronic health records at Montefiore Medical Center, NY. We included adults ≥18 years admitted to the ICU with ARF on mechanical ventilation (MV) with either Influenza PCR positive (Flu) from the 2017 or 2018 Influenza seasons or SARS-CoV-2 PCR positive (COVID) from March-May 2020. We reviewed chest X-rays for bilateral interstitial infiltrates and PF ratio ≤300 for ARDS. We compared demographics, in-hospital mortality and hospital and ICU length of stay (LOS) using Fisher’s Exact, Wilcoxon Mann-Whitney and Student’s T-tests. P-values < 0.05 were considered statistically significant.
Results: 297 patients were included of which 76 (25.6%) had Flu and 221 (74.4%) had COVID. Flu patients were older than COVID (Flu 65.5 +/- 14.5 vs COVID 58.6 +/- 13.2 years, p=0.0002). Higher proportion of Flu patients were women(n=44, 57.9%), and more men had COVID (n=139, 64.4%), p=0.001. COVID was more common in Black (n=80, 36.3%) and other race (n=120, 54.3%) than whites (n=21, 9.5%) compared to Flu with Black (n=23, 30.3%), Other Race (n=35, 46.1%), and whites (n=18, 23.7%), p=0.01. ARF with COVID were more likely to have ARDS (COVID n=204 (92.3%) and Flu n=45 (59.2%), p< 0.001).
In-hospital mortality was higher in ARF with COVID (n=137, 63.7%) versus Flu (n=23, 30.3%), p< 0.001. The hospital LOS was higher in Flu but there was no difference in the ICU length of stay [Flu Hospital LOS 19.5 days(Interquartile Range (IQR) 11.8, 27.5) and COVID 14.5 days(IQR 8.8,24.5), p=0.004; Flu ICU LOS 8.6 days (IQR 4.4,14.6) versus COVID 5.7 days(IQR 2.8,16), p=0.25]. Duration on MV with COVID (10 days, IQR 6,19) was longer than Flu (6 days (IQR 3,16). The ventilator free days at 28 days was longer in Flu (18 (IQR 0,25 days) than COVID (0 (IQR 0,0 days), p< 0.0001).
Conclusion: We saw age, race and gender discrepancy in ARF from Influenza and SARS-CoV-2. Majority of the intubated patients with ARF due to COVID in the ICU met the ARDS criteria relative to Influenza and had a higher mortality rate. Surge conditions likely contributed to the high morbidity and mortality in SARS-CoV2 ARF in addition to other confounding factors.