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

被引：0

作者：

Heo, I. Re ^{[1
]}

Kim, Tae Hoon ^{[1
]}

Jung, Won Jai ^{[2
]}

Seong, Gil Myeong ^{[3
]}

Kwon, Sun Jung ^{[4
]}

Moon, Jae Young ^{[5
]}

Lee, Song-, I ^{[6
]}

Moon, Do Sik ^{[7
]}

Kim, Tae-Ok ^{[8
]}

Park, Chul ^{[9
]}

Choi, Eun Young ^{[10
,11
]}

Yoo, Jung-Wan ^{[12
]}

Park, Sunghoon ^{[13
]}

Baek, Ae Rin ^{[14
]}

Lim, Sung Yoon ^{[15
]}

Kim, Jung Soo ^{[16
]}

Lee, Jongmin ^{[17
]}

Chung, Chi Ryang ^{[18
]}

Lee, Sang-Min ^{[19
]}

Lee, Su Hwan ^{[20
]}

Baek, Moon Seong ^{[21
]}

Huh, Jin Won ^{[22
]}

Cho, Woo Hyun ^{[23
]}

Kim, Ho Cheol ^{[1
]}

机构：

[1] Gyeongsang Natl Univ, Changwon Hosp, Coll Med, Dept Internal Med, 11 Samjeongja Ro, Chang Won 51472, South Korea

[2] Korea Univ, Div Pulm Allergy & Crit Care Med, Anam Hosp, Seoul, South Korea

[3] Jeju Natl Univ, Jeju Natl Univ Hosp, Sch Med, Dept Internal Med, Jeju, South Korea

[4] Konyang Univ Hosp, Dept Internal Med, Div Resp & Crit Care Med, Daejeon, South Korea

[5] Chungnam Natl Univ, Sejong Hosp, Coll Med, Dept Internal Med, Sejong, South Korea

[6] Chungnam Natl Univ, Chungnam Natl Univ Hosp, Dept Internal Med, Div Pulm & Crit Care Med,Coll Med, Daejeon, South Korea

[7] Chosun Univ Hosp, Dept Pulmonol & Crit Care Med, Gwangju, South Korea

[8] Chonnam Natl Univ Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Gwangju, South Korea

[9] Wonkwang Univ Hosp, Div Pulmonol & Crit Care Med, Iksan, South Korea

[10] Yeungnam Univ, Coll Med, Dept Internal Med, Div Pulmonol & Allergy, Daegu, South Korea

[11] Yeungnam Univ, Reg Ctr Resp Dis, Med Ctr, Daegu, South Korea

[12] Gyeongsang Natl Univ Hosp, Dept Internal Med, Jinju, South Korea

[13] Hallym Univ, Sacred Heart Hosp, Div Pulm Allergy & Crit Care Med, Anyang, South Korea

[14] Soonchunhyang Univ, Bucheon Hosp, Dept Internal Med, Div Allergy & Pulm Med, Bucheon, South Korea

[15] Seoul Natl Univ, Bundang Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Seongnam, South Korea

[16] Inha Univ, Coll Med, Dept Hosp Med, Div Crit Care Med, Incheon 22332, South Korea

[17] Catholic Univ Korea, Seoul St Marys Hosp, Div Pulm & Crit Care Med, Dept Internal Med,Coll Med, Seoul, South Korea

[18] Sungkyunkwan Univ, Samsung Med Ctr, Sch Med, Dept Crit Care Med, Seoul, South Korea

[19] Seoul Natl Univ, Seoul Natl Univ Hosp, Dept Internal Med, Div Pulm & Crit Care Med,Coll Med, Seoul, South Korea

[20] Yonsei Univ, Severance Hosp, Dept Internal Med, Div Pulmonol & Crit Care Med,Coll Med, Seoul, South Korea

[21] Chung Ang Univ, Chung Ang Univ Hosp, Coll Med, Dept Internal Med, Seoul, South Korea

[22] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Pulm & Crit Care Med, Seoul, South Korea

[23] Pusan Natl Univ, Yangsan Hosp, Res Inst Convergence Biomed Sci & Technol, Dept Internal Med,Div Allergy Pulm & Crit Care Med, Yangsan, South Korea

来源：

TUBERCULOSIS AND RESPIRATORY DISEASES | 2025年 / 88卷 / 03期

关键词：

COVID-19; Life-Sustaining Treatments; Intensive Care Unit; Mechanical Ventilation; Extracorporeal Membrane Oxygenation; Predictors; Retrospective Cohort; Korea; DECISION-MAKING; SUPPORT;

D O I：

10.4046/trd.2024.0137

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

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.

引用

页码：557 / 565

页数：9

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