240: TRENDS IN ARDS MORTALITY BEFORE AND DURING THE COVID-19 PANDEMIC

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Introduction: Mortality among patients with acute respiratory distress syndrome (ARDS) has changed minimally according to a recent meta-analysis, but contemporary longitudinal studies are lacking. We examined the population-level mortality trajectories of ARDS patients before and during the COVID-19 pandemic. Methods: We used a statewide dataset to identify hospitalizations with ARDS and mechanical ventilation aged ≥18 in Texas, from January 1, 2016 to December 31, 2023. ARDS and COVID-19 were defined as ICD-10 code J80 and U071, respectively. Interrupted time series analyses (ITSA), with segmented hierarchical logistic models were used to estimate the prepandemic (1/1/2016-3/31/2020) trend, level (intercept) change, pandemic (4/1/2020-12/31/2023) trend, and change in trends in short-term mortality (defined as in-hospital death or discharge to hospice) among ARDS hospitalizations overall, among demographic strata, and on sensitivity analyses of non-COVID hospitalizations. Models were expressed as average marginal effects (AME), indicating change in absolute probability of death. Results: Among 28,266 mechanically ventilated ARDS hospitalizations (5,746 [20.3%] prepandemic and 22,520 [79.7%] pandemic), there were 13,771 (48.7%) female, 10,919 (38.6%) aged ≥65 years, 15,831 (56.0%) were racial and ethnic minorities, and 15,680 (55.5%) had a COVID-19 diagnosis. Short-term mortality during the prepandemic and pandemic periods was 46.8% and 68.2%, respectively. On ITSA, short-term mortality decreased during the prepandemic period (AME 0.25%/quarter [95% CI -0.44 to -0.06]), with level change (3.24% [95% CI 0.74 to 5.74]) and rising mortality during the pandemic period (0.30%/quarter [(95% CI 0.14 to 0.46]), with significant trend change (p< 0.0001). These findings were generally consistent on subgroup and sensitivity analyses, except among ARDS hospitalizations aged 45-64 years, males, Black people and those of Other race and ethnicity group, where short-term mortality remained unchanged during the prepandemic period. Conclusions: Among patients with ARDS, gains in short-term mortality were reversed by the COVID-19 pandemic. However, these prepandemic outcome gains were not shared equitably. The pandemic-associated outcome setback was not driven by ARDS patients with COVID-19.

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