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

초록

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. CONCLUSIONS: Age, comorbidities, and ICU interventions significantly influence LST decisions, highlighting the need for ethical and evidence-based critical care guidelines.

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