Discussion
multiorgan dysfunction, acute lung injury, disability, ARDS
SECONDARY, ARDS, SEQUELAE
Long-term sequelae after ICU therapy in patients with ARDS have become an increasing subject of interest in recent years, especially since the COVID-19 pandemic. The question of whether COVID-19 ARDS is associated with a higher mortality rate and increased risk of long-term impairment compared to ARDS of other origins is widely discussed. Similar to previous findings [Previous research has shown that patients with COVID-19 have a high prevalence of disability after ICU treatment [It is unquestionable that patients with ARDS are at risk of sustaining long-term impairment. Previous studies have described impaired quality of life and pulmonary function in patients with acute lung injury [The identification of risk factors for impairment after ARDS survival might provide the opportunity to intervene specifically to improve patient outcomes. Similar to previous studies, this study shows that age is a significant but non-amendable factor for disability after discharge [In addition to age, our findings revealed that health status on day 5 in ICU (reflected by the SOFA score) significantly impacted disability after discharge. Our results are consistent with Herridge et al. [The SOFA score was chosen because it is an estimated marker for mortality in ICU patients [For COVID-19 ARDS, the SOFA score dynamic up to day 5 was not significant.Independent of the dynamic, however, the SOFA score on day 5 significantly influenced disability after ARDS in both groups. This shows the importance of the state of the patient on day 5.However, the question arises if the outcome depends on the well-timed initiation of therapy [Our data are limited, as we did not evaluate patients’ health status prior to their ICU admission. Data on frailty, specifically, prior to ICU admission were not surveyed; however, it would have been of interest since frailty per se is a predictor for ICU  length of stay, length of mechanical ventilation, and mortality [Our study was not primarily designed to define the quality of life or compare COVID-19 ARDS with ARDS of other origins, but is a secondary analysis of the interventional ThIlo trial.The trial started in the spring of 2019, before the beginning of the COVID-19 pandemic, and lasted until spring of 2021. During the course of the pandemic, specific treatment of COVID-19 patients changed, and in the beginning varied from “wave to wave”. Therefore, systematic comparison of COVID-19 ARDS with non-COVID-ARDS is not as simple. All in all, there certainly were variables-also within the therapy-which differed over time, and were not systematically evaluated and compared. As data were collected up until spring of 2021, none of our COVID-19 patients were vaccinated. Therefore, our results might not reflect the current morbidity and mortality that COVID-19 ARDS brings with it, as vaccination and more specific COVID-19 treatment is available now.In summary, the mortality of COVID-19 ARDS in our study population was not higher than that of ARDS of other origins and was not associated with an increased risk of disability. In both groups, early recovery from multiorgan dysfunction reduced disability after ICU discharge. The development of SOFA score within the first 5 days or SOFA score on day 5 significantly impacted patient outcome. Further research on the timing of intensive care treatment could help reduce mortality and health care costs in patients with ARDS.