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

Background: Understanding of the life-sustaining treatment (LST) decisions in critically ill coronavirus disease 2019 (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 intensive care units (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 years vs. 67 years, p<0.001), and had more comorbidities (85.5% vs. 70.4%, p<0.001), especially cardiovascular and chronic lung disease. They showed higher blood urea nitrogen, 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 extracorporeal membrane oxygenation (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 (odds ratio [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. Conclusion: Age, comorbidities, and ICU interventions significantly influence LST decisions, highlighting the need for ethical and evidence-based critical care guidelines.