{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T16:45:52Z","timestamp":1765039552412,"version":"build-2065373602"},"reference-count":36,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,2,2]],"date-time":"2021-02-02T00:00:00Z","timestamp":1612224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["P400PM_183865"],"award-info":[{"award-number":["P400PM_183865"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Bangerter-Rhyner Foundation","award":["xxx"],"award-info":[{"award-number":["xxx"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The mortality of COVID-19 patients in the intensive care unit (ICU) is influenced by their state at admission. We aimed to model COVID-19 acute respiratory distress syndrome state transitions from ICU admission to day 60 outcome and to evaluate possible prognostic factors. We analyzed a prospective French database that includes critically ill COVID-19 patients. A six-state multistate model was built and 17 transitions were analyzed either using a non-parametric approach or a Cox proportional hazard model. Corticosteroids and IL-antagonists (tocilizumab and anakinra) effects were evaluated using G-computation. We included 382 patients in the analysis: 243 patients were admitted to the ICU with non-invasive ventilation, 116 with invasive mechanical ventilation, and 23 with extracorporeal membrane oxygenation. The predicted 60-day mortality was 25.9% (95% CI: 21.8%\u201330.0%), 44.7% (95% CI: 48.8%\u201350.6%), and 59.2% (95% CI: 49.4%\u201369.0%) for a patient admitted in these three states, respectively. Corticosteroids decreased the risk of being invasively ventilated (hazard ratio (HR) 0.59, 95% CI: 0.39\u20130.90) and IL-antagonists increased the probability of being successfully extubated (HR 1.8, 95% CI: 1.02\u20133.17). Antiviral drugs did not impact any transition. In conclusion, we observed that the day-60 outcome in COVID-19 patients is highly dependent on the first ventilation state upon ICU admission. Moreover, we illustrated that corticosteroid and IL-antagonists may influence the intubation duration.<\/jats:p>","DOI":"10.3390\/jcm10030544","type":"journal-article","created":{"date-parts":[[2021,2,2]],"date-time":"2021-02-02T13:01:12Z","timestamp":1612270872000},"page":"544","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Multistate Modeling of COVID-19 Patients Using a Large Multicentric Prospective Cohort of Critically Ill Patients"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5709-4322","authenticated-orcid":false,"given":"Moreno","family":"Ursino","sequence":"first","affiliation":[{"name":"F-CRIN PARTNERS Platform, AP-HP, Universit\u00e9 de Paris, Inserm, F-75010 Paris, France"},{"name":"INSERM, Centre de Recherche des Cordeliers, Sorbonne Universit\u00e9, USPC, Universit\u00e9 de Paris, F-75006 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Dupuis","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Gabriel Montpied University Hospital, 63000 Clermont-Ferrand, France"},{"name":"Inserm U 1137, Universit\u00e9 de Paris, Sorbonne Paris Cite, 75870 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niccol\u00f2","family":"Buetti","sequence":"additional","affiliation":[{"name":"Inserm U 1137, Universit\u00e9 de Paris, Sorbonne Paris Cite, 75870 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Etienne","family":"de Montmollin","sequence":"additional","affiliation":[{"name":"Inserm U 1137, Universit\u00e9 de Paris, Sorbonne Paris Cite, 75870 Paris, France"},{"name":"APHP, Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard Hospital, 75018 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lila","family":"Bouadma","sequence":"additional","affiliation":[{"name":"Inserm U 1137, Universit\u00e9 de Paris, Sorbonne Paris Cite, 75870 Paris, France"},{"name":"APHP, Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard Hospital, 75018 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dany","family":"Golgran-Toledano","sequence":"additional","affiliation":[{"name":"Polyvalent ICU, Groupe Hospitalier Intercommunal Le Raincy Montfermeil, 93370 Montfermeil, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"St\u00e9phane","family":"Ruckly","sequence":"additional","affiliation":[{"name":"Inserm U 1137, Universit\u00e9 de Paris, Sorbonne Paris Cite, 75870 Paris, France"},{"name":"ICUREsearch, Statistical Department, 38160 Saint Marcellin, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathilde","family":"Neuville","sequence":"additional","affiliation":[{"name":"Polyvalent ICU, H\u00f4pital Foch, 92150 Suresnes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yves","family":"Cohen","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, CHU Avicenne, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 93000 Bobigny, France"},{"name":"UFR SMBH, Universit\u00e9 Sorbonne Paris Nord, 93000 Bobigny, France"},{"name":"INSERM, U942, F-75010, 75010 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Mourvillier","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Robert Debr\u00e9 University Hospital, 51100 Reims, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7690-6779","authenticated-orcid":false,"given":"Bertrand","family":"Souweine","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Gabriel Montpied University Hospital, 63000 Clermont-Ferrand, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Gainnier","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive R\u00e9animation, La Timone 2 University Hospital, 13385 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginie","family":"Laurent","sequence":"additional","affiliation":[{"name":"Medical-Surgical Intensive Care Unit, Andr\u00e9 Mignot Hospital, 78150 Le Chesnay, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4036-6245","authenticated-orcid":false,"given":"Nicolas","family":"Terzi","sequence":"additional","affiliation":[{"name":"INSERM, U1042, Universit\u00e9 Grenoble-Alpes, HP2, 38000 Grenoble, France"},{"name":"M\u00e9decine Intensive R\u00e9animation, CHU Grenoble-Alpes, 38700 Grenoble, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shidasp","family":"Siami","sequence":"additional","affiliation":[{"name":"Polyvalent ICU, Centre Hospitalier Sud Essonne Dourdan-Etampes, 91410 Dourdan, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3768-3496","authenticated-orcid":false,"given":"Jean","family":"Reignier","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive R\u00e9animation, CHU de Nantes, 44000 Nantes, 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