PREDICTING THE SUCCESS OF HFNC FOR TREATING ARDS DUE TO COVID-19: THE ROLE OF INFLAMMATORY BIOMARKERS

SESSION TITLE: Critical Care Posters 13 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: COVID-19 infection can cause pneumonia and acute respiratory distress syndrome (ARDS), which is associated with high mortality. Treatment with HFNC can reduce the need for endotracheal intubation and ICU admission, but factors predicting the success of HFNC at the time of initiation have not been well-characterized. Few large studies have evaluated the predictive value of inflammatory serum biomarkers such as C-reactive protein (CRP), D-dimer, ferritin, and lactate dehydrogenase (LDH) for successful HFNC management in COVID-19 patients. Our objective was to determine if inflammatory biomarkers can be used to predict successful treatment with HFNC in patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia. METHODS: We retrospectively studied 432 consecutive patients who were admitted to the Queen’s Medical Center from August 2020 to October 2022 and treated with HFNC for acute hypoxemic respiratory failure due to COVID-19 pneumonia. Patients designated as “Do Not Intubate” status or on HFNC for post-extubation respiratory failure were excluded. Measurements of CRP, D-dimer, ferritin, and LDH near the time of HFNC application were compared in patients who were successfully managed with HFNC and those who required intubation, using the Wilcoxon rank-sum test. RESULTS: 323 patients were included in the final analysis. 43.3% (n=140) were successfully managed with HFNC, while 56.7% (n=183) were intubated. The percentage of Asian patients (n=131) who were intubated was 60.3%, the percentage of Native Hawaiian/Pacific Islander patients (n=132) who were intubated was 56.8%, and the percentage of White patients (n=55) who were intubated was 50.9%. The median LDH was 532 (n=37) in the non-intubated group and 611 (n=41) in the intubated group (p=0.032). When patients with pulmonary embolism or deep vein thrombosis were excluded, 49.2% (n=124) were successfully managed with HFNC, while 50.8% (n=128) required intubation. For these patients, the median D-dimer was 0.94 in the non-intubated group and 1.18 in the intubated group (p=0.046), the median ferritin was 1385 in the non-intubated group and 1921 in the intubated group (p=0.043), and the median CRP was 60 in the non-intubated group and 97 in the intubated group (p<0.001). CONCLUSIONS: To our knowledge, this is the largest study reviewing the relationship between HFNC success and these serum biomarkers in COVID-19 patients. CRP, D-dimer, ferritin, and LDH were significantly higher when comparing those who were intubated to those who were successfully managed with HFNC. CLINICAL IMPLICATIONS: Serum biomarkers may help to identify patients who can be successfully treated with HFNC, and those at higher risk for intubation. DISCLOSURES: No relevant relationships by Gehan Devendra No relevant relationships by Reid Ikeda No relevant relationships by Koichi Keitoku No relevant relationships by Andrew Pham