Outcomes of acute respiratory distress syndrome in COVID-19 patients compared to the general population: a systematic review and meta-analysis

ABSTRACT

Introduction

Acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) often leads to mortality. Outcomes of patients with COVID-19-related ARDS compared to ARDS unrelated to COVID-19 is not well characterized.

Areas covered

We performed a systematic review of PubMed, Scopus, and MedRxiv 11/1/2019 to 3/1/2021, including studies comparing outcomes in COVID-19-related ARDS (COVID-19 group) and ARDS unrelated to COVID-19 (ARDS group). Outcomes investigated were duration of mechanical ventilation-free days, intensive care unit (ICU) length-of-stay (LOS), hospital LOS, and mortality. Random effects models were fit for each outcome measure. Effect sizes were reported as pooled median differences of medians (MDMs), mean differences (MDs), or odds ratios (ORs).

Expert opinion

Ten studies with 2,281 patients met inclusion criteria (COVID-19: 861 [37.7%], ARDS: 1420 [62.3%]). There were no significant differences between the COVID-19 and ARDS groups for median number of mechanical ventilator-free days (MDM: −7.0 [95% CI: −14.8; 0.7], p = 0.075), ICU LOS (MD: 3.1 [95% CI: −5.9; 12.1], p = 0.501), hospital LOS (MD: 2.5 [95% CI: −5.6; 10.7], p = 0.542), or all-cause mortality (OR: 1.25 [95% CI: 0.78; 1.99], p = 0.361). Compared to the general ARDS population, results did not suggest worse outcomes in COVID-19-related ARDS.

KEYWORDS:

• Respiratory distress syndrome
• covid-19
• sars-cov-2
• artificial respiration
• mechanical ventilators
• length of stay
• intensive care units

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors acknowledge Karl Holub, Stephen Mead, and Darian Lehmann-Plantenberg for their design and support of the Nested Knowledge meta-analytical software.

Declaration of interest

NLR, SK, JR, AB, MS, DS, and KC work for Nested Knowledge and Superior Medical Experts. KWE, GP, ARD, and MA. JCT is employed by and has ownership interest in Superior Medical Experts. KMK works for and holds equity in Nested Knowledge and Superior Medical Experts. JMP is employed by and has ownership interest in Nested Knowledge and Superior Medical Experts. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Data availability statement

Additional data not contained in the article is available upon reasonable request.

Supplemental data

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Additional information

Funding

This paper was not funded.