Dataset Information

Association of Surge Conditions with Mortality Among Critically Ill Patients with COVID-19.

ABSTRACT:

Objective

To determine whether surge conditions were associated with increased mortality.

Design

Multicenter cohort study.

Setting

U.S. ICUs participating in STOP-COVID.

Patients

Consecutive adults with COVID-19 admitted to participating ICUs between March 4 and July 1, 2020.

Interventions

None.

Measurements and main results

The main outcome was 28-day in-hospital mortality. To assess the association between admission to an ICU during a surge period and mortality, we used two different strategies: (1) an inverse probability weighted difference-in-differences model limited to appropriately matched surge and non-surge patients and (2) a meta-regression of 50 multivariable difference-in-differences models (each based on sets of randomly matched surge- and non-surge hospitals). In the first analysis, we considered a single surge period for the cohort (March 23 - May 6). In the second, each surge hospital had its own surge period (which was compared to the same time periods in matched non-surge hospitals).Our cohort consisted of 4342 ICU patients (average age 60.8 [sd 14.8], 63.5% men) in 53 U.S. hospitals. Of these, 13 hospitals encountered surge conditions. In analysis 1, the increase in mortality seen during surge was not statistically significant (odds ratio [95% CI]: 1.30 [0.47-3.58], p = .6). In analysis 2, surge was associated with an increased odds of death (odds ratio 1.39 [95% CI, 1.34-1.43], p < .001).

Conclusions

Admission to an ICU with COVID-19 in a hospital that is experiencing surge conditions may be associated with an increased odds of death. Given the high incidence of COVID-19, such increases would translate into substantial excess mortality.

SUBMITTER: Keene AB

PROVIDER: S-EPMC8926920 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Association of Surge Conditions with Mortality Among Critically Ill Patients with COVID-19.

Keene Adam B AB Admon Andrew J AJ Brenner Samantha K SK Gupta Shruti S Lazarous Deepa D Leaf David E DE Gershengorn Hayley B HB

Journal of intensive care medicine 20211223 4

<h4>Objective</h4>To determine whether surge conditions were associated with increased mortality.<h4>Design</h4>Multicenter cohort study.<h4>Setting</h4>U.S. ICUs participating in STOP-COVID.<h4>Patients</h4>Consecutive adults with COVID-19 admitted to participating ICUs between March 4 and July 1, 2020.<h4>Interventions</h4>None.<h4>Measurements and main results</h4>The main outcome was 28-day in-hospital mortality. To assess the association between admission to an ICU during a surge period and ...[more]

PMID: 34939474

Similar Datasets

Project description:ImportanceTherapies that improve survival in critically ill patients with coronavirus disease 2019 (COVID-19) are needed. Tocilizumab, a monoclonal antibody against the interleukin 6 receptor, may counteract the inflammatory cytokine release syndrome in patients with severe COVID-19 illness.ObjectiveTo test whether tocilizumab decreases mortality in this population.Design, setting, and participantsThe data for this study were derived from a multicenter cohort study of 4485 adults with COVID-19 admitted to participating intensive care units (ICUs) at 68 hospitals across the US from March 4 to May 10, 2020. Critically ill adults with COVID-19 were categorized according to whether they received or did not receive tocilizumab in the first 2 days of admission to the ICU. Data were collected retrospectively until June 12, 2020. A Cox regression model with inverse probability weighting was used to adjust for confounding.ExposuresTreatment with tocilizumab in the first 2 days of ICU admission.Main outcomes and measuresTime to death, compared via hazard ratios (HRs), and 30-day mortality, compared via risk differences.ResultsAmong the 3924 patients included in the analysis (2464 male [62.8%]; median age, 62 [interquartile range {IQR}, 52-71] years), 433 (11.0%) received tocilizumab in the first 2 days of ICU admission. Patients treated with tocilizumab were younger (median age, 58 [IQR, 48-65] vs 63 [IQR, 52-72] years) and had a higher prevalence of hypoxemia on ICU admission (205 of 433 [47.3%] vs 1322 of 3491 [37.9%] with mechanical ventilation and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen of <200 mm Hg) than patients not treated with tocilizumab. After applying inverse probability weighting, baseline and severity-of-illness characteristics were well balanced between groups. A total of 1544 patients (39.3%) died, including 125 (28.9%) treated with tocilizumab and 1419 (40.6%) not treated with tocilizumab. In the primary analysis, during a median follow-up of 27 (IQR, 14-37) days, patients treated with tocilizumab had a lower risk of death compared with those not treated with tocilizumab (HR, 0.71; 95% CI, 0.56-0.92). The estimated 30-day mortality was 27.5% (95% CI, 21.2%-33.8%) in the tocilizumab-treated patients and 37.1% (95% CI, 35.5%-38.7%) in the non-tocilizumab-treated patients (risk difference, 9.6%; 95% CI, 3.1%-16.0%).Conclusions and relevanceAmong critically ill patients with COVID-19 in this cohort study, the risk of in-hospital mortality in this study was lower in patients treated with tocilizumab in the first 2 days of ICU admission compared with patients whose treatment did not include early use of tocilizumab. However, the findings may be susceptible to unmeasured confounding, and further research from randomized clinical trials is needed.

Project description:BackgroundHispanic persons living in the United States (U.S.) are at higher risk of infection and death from coronavirus disease 2019 (COVID-19) compared with non-Hispanic persons. Whether this disparity exists among critically ill patients with COVID-19 is unknown.ObjectiveTo evaluate ethnic disparities in mortality among critically ill adults with COVID-19 enrolled in the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID).MethodsMulticenter cohort study of adults with laboratory-confirmed COVID-19 admitted to intensive care units (ICU) at 67 U.S. hospitals from March 4 to May 9, 2020. Multilevel logistic regression was used to evaluate 28-day mortality across racial/ethnic groups.ResultsA total of 2153 patients were included (994 [46.2%] Hispanic and 1159 [53.8%] non-Hispanic White). The median (IQR) age was 62 (51-71) years (non-Hispanic White, 66 [57-74] years; Hispanic, 56 [46-67] years), and 1462 (67.9%) were men. Compared with non-Hispanic White patients, Hispanic patients were younger; were less likely to have hypertension, chronic obstructive pulmonary disease, coronary artery disease, or heart failure; and had longer duration of symptoms prior to ICU admission. During median (IQR) follow-up of 14 (7-24) days, 785 patients (36.5%) died. In analyses adjusted for age, sex, clinical characteristics, and hospital size, Hispanic patients had higher odds of death compared with non-Hispanic White patients (OR, 1.44; 95% CI, 1.12-1.84).ConclusionsAmong critically ill adults with COVID-19, Hispanic patients were more likely to die than non-Hispanic White patients, even though they were younger and had lower comorbidity burden. This finding highlights the need to provide earlier access to care to Hispanic individuals with COVID-19, especially given our finding of longer duration of symptoms prior to ICU admission among Hispanic patients. In addition, there is a critical need to address ongoing disparities in post hospital discharge care for patients with COVID-19.

Dataset Information

Association of Surge Conditions with Mortality Among Critically Ill Patients with COVID-19.

Objective

Design

Setting

Patients

Interventions

Measurements and main results

Conclusions

Publications

Association of Surge Conditions with Mortality Among Critically Ill Patients with COVID-19.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets