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Global variability in admission to intensive care units for patients with chronic liver disease and COVID-19: International registry data
Hepatology ; 74(SUPPL 1):318A-319A, 2021.
Article in English | EMBASE | ID: covidwho-1508736
ABSTRACT

Background:

The COVID-19 pandemic has provided a unique opportunity to evaluate global intensive care unit (ICU) admission practices. Patients with chronic liver disease (CLD) and cirrhosis may have limited or variable access to ICU. We aimed to describe international ICU admission rates and outcomes in critically-ill patients with CLD and COVID-19.

Methods:

Data were combined from two international registries (SECURE-Liver and COVID-Hep) for patients with CLD and lab-confirmed COVID-19 deemed sick enough to require ICU admission by the reporting clinician. Rates of ICU admission or decline, and respective outcomes were compared by country. We performed a secondary analysis comparing ICU admissions/declines and outcomes from the United States (US) and United Kingdom (UK), the two greatest contributing countries.

Results:

Between 25 March 2020 and 3 February 2021, 319 patients with CLD and COVID-19 from 27 countries were deemed to require ICU care. There was considerable country-level variability in ICU decline rates (Figure 1A), although mortality following ICU admission was similar by country (Figure 1B). Rates of ICU admission differed significantly between the US (75/79, 95%) and UK (22/77, 29%) (p<0.001). However, there were no differences in the US and UK in mortality after ICU admission (42/75 [56%] vs. 10/22 [45%];p=0.468;Figure 1B) or mortality after invasive ventilation (29/59 [49%] vs. 9/17 [53%];p=1.000). Both in those requiring ICU admission and admitted to the ICU, there were no differences in age, sex, Charlson Comorbidity Index or Child Pugh Score. Only four US patients were declined ICU admission of whom 2 (50%) died compared to 55 UK patients declined ICU admission of whom 51 (93%) died. Baseline factors associated with being declined ICU admission in the UK were older age, alcohol-related liver disease, and Child B/C cirrhosis. In both US and UK cohorts, the reason for not admitting patients to ICU was due to this being deemed inappropriate (futile) by the responsible clinician, except for one case in both countries in which no ICU bed was available. Information relating to patient goals of care, longterm outcomes in survivors, and granular detail regarding organ support requirements were not available.

Conclusion:

Patients with CLD and critical COVID-19 were over 3-times more likely to be admitted to ICU in the US than the UK despite having similar baseline characteristics. However, the rates of mortality following ICU admission were comparable between the two countries. ICU bed availability was not a key factor in decline rates. The differing thresholds for escalation to ICU with similar post admission outcomes warrants further discussion.

Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Hepatology Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Hepatology Year: 2021 Document Type: Article