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Trends in ICU Mortality From Coronavirus Disease 2019: A Tale of Three Surges.
Auld, Sara C; Harrington, Kristin R V; Adelman, Max W; Robichaux, Chad J; Overton, Elizabeth C; Caridi-Scheible, Mark; Coopersmith, Craig M; Murphy, David J.
  • Auld SC; Emory Critical Care Center (ECCC), Atlanta, GA.
  • Harrington KRV; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
  • Adelman MW; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.
  • Robichaux CJ; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
  • Overton EC; Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA.
  • Caridi-Scheible M; Georgia Clinical and Translational Science Alliance (CTSA), Atlanta, GA.
  • Coopersmith CM; Office of Quality and Risk, Emory Healthcare, Atlanta, GA.
  • Murphy DJ; Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA.
Crit Care Med ; 50(2): 245-255, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1672309
ABSTRACT

OBJECTIVES:

To determine the association between time period of hospitalization and hospital mortality among critically ill adults with coronavirus disease 2019.

DESIGN:

Observational cohort study from March 6, 2020, to January 31, 2021.

SETTING:

ICUs at four hospitals within an academic health center network in Atlanta, GA. PATIENTS Adults greater than or equal to 18 years with coronavirus disease 2019 admitted to an ICU during the study period (i.e., Surge 1 March to April, Lull 1 May to June, Surge 2 July to August, Lull 2 September to November, Surge 3 December to January). MEASUREMENTS AND MAIN

RESULTS:

Among 1,686 patients with coronavirus disease 2019 admitted to an ICU during the study period, all-cause hospital mortality was 29.7%. Mortality differed significantly over time 28.7% in Surge 1, 21.3% in Lull 1, 25.2% in Surge 2, 30.2% in Lull 2, 34.7% in Surge 3 (p = 0.007). Mortality was significantly associated with 1) preexisting risk factors (older age, race, ethnicity, lower body mass index, higher Elixhauser Comorbidity Index, admission from a nursing home); 2) clinical status at ICU admission (higher Sequential Organ Failure Assessment score, higher d-dimer, higher C-reactive protein); and 3) ICU interventions (receipt of mechanical ventilation, vasopressors, renal replacement therapy, inhaled vasodilators). After adjusting for baseline and clinical variables, there was a significantly increased risk of mortality associated with admission during Lull 2 (relative risk, 1.37 [95% CI = 1.03-1.81]) and Surge 3 (relative risk, 1.35 [95% CI = 1.04-1.77]) as compared to Surge 1.

CONCLUSIONS:

Despite increased experience and evidence-based treatments, the risk of death for patients admitted to the ICU with coronavirus disease 2019 was highest during the fall and winter of 2020. Reasons for this increased mortality are not clear.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Hospital Mortality / SARS-CoV-2 / COVID-19 / Hospitalization / Intensive Care Units Type of study: Cohort study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Crit Care Med Year: 2022 Document Type: Article Affiliation country: CCM.0000000000005185

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Hospital Mortality / SARS-CoV-2 / COVID-19 / Hospitalization / Intensive Care Units Type of study: Cohort study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Crit Care Med Year: 2022 Document Type: Article Affiliation country: CCM.0000000000005185