tetano
Editor, Senior Moderator
JAMA Intern Med
. 2020 Jul 15.
doi: 10.1001/jamainternmed.2020.3596. Online ahead of print.
Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US
Shruti Gupta[SUP] 1 [/SUP], Salim S Hayek[SUP] 2 [/SUP], Wei Wang[SUP] 3 [/SUP], Lili Chan[SUP] 4 [/SUP], Kusum S Mathews[SUP] 5 6 [/SUP], Michal L Melamed[SUP] 7 [/SUP], Samantha K Brenner[SUP] 8 9 [/SUP], Amanda Leonberg-Yoo[SUP] 10 [/SUP], Edward J Schenck[SUP] 11 [/SUP], Jared Radbel[SUP] 12 [/SUP], Jochen Reiser[SUP] 13 [/SUP], Anip Bansal[SUP] 14 [/SUP], Anand Srivastava[SUP] 15 [/SUP], Yan Zhou[SUP] 16 [/SUP], Anne Sutherland[SUP] 17 [/SUP], Adam Green[SUP] 18 [/SUP], Alexandre M Shehata[SUP] 19 [/SUP], Nitender Goyal[SUP] 20 [/SUP], Anitha Vijayan[SUP] 21 [/SUP], Juan Carlos Q Velez[SUP] 22 23 [/SUP], Shahzad Shaefi[SUP] 24 [/SUP], Chirag R Parikh[SUP] 25 [/SUP], Justin Arunthamakun[SUP] 26 [/SUP], Ambarish M Athavale[SUP] 27 [/SUP], Allon N Friedman[SUP] 28 [/SUP], Samuel A P Short[SUP] 29 [/SUP], Zoe A Kibbelaar[SUP] 30 [/SUP], Samah Abu Omar[SUP] 1 [/SUP], Andrew J Admon[SUP] 31 32 [/SUP], John P Donnelly[SUP] 32 33 [/SUP], Hayley B Gershengorn[SUP] 34 35 [/SUP], Miguel A Hern?n[SUP] 36 37 38 [/SUP], Matthew W Semler[SUP] 39 [/SUP], David E Leaf[SUP] 1 [/SUP], STOP-COVID Investigators
Affiliations
Abstract
Importance: The US is currently an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet few national data are available on patient characteristics, treatment, and outcomes of critical illness from COVID-19.
Objectives: To assess factors associated with death and to examine interhospital variation in treatment and outcomes for patients with COVID-19.
Design, setting, and participants: This multicenter cohort study assessed 2215 adults with laboratory-confirmed COVID-19 who were admitted to intensive care units (ICUs) at 65 hospitals across the US from March 4 to April 4, 2020.
Exposures: Patient-level data, including demographics, comorbidities, and organ dysfunction, and hospital characteristics, including number of ICU beds.
Main outcomes and measures: The primary outcome was 28-day in-hospital mortality. Multilevel logistic regression was used to evaluate factors associated with death and to examine interhospital variation in treatment and outcomes.
Results: A total of 2215 patients (mean [SD] age, 60.5 [14.5] years; 1436 [64.8%] male; 1738 [78.5%] with at least 1 chronic comorbidity) were included in the study. At 28 days after ICU admission, 784 patients (35.4%) had died, 824 (37.2%) were discharged, and 607 (27.4%) remained hospitalized. At the end of study follow-up (median, 16 days; interquartile range, 8-28 days), 875 patients (39.5%) had died, 1203 (54.3%) were discharged, and 137 (6.2%) remained hospitalized. Factors independently associated with death included older age (≥80 vs <40 years of age: odds ratio [OR], 11.15; 95% CI, 6.19-20.06), male sex (OR, 1.50; 95% CI, 1.19-1.90), higher body mass index (≥40 vs <25: OR, 1.51; 95% CI, 1.01-2.25), coronary artery disease (OR, 1.47; 95% CI, 1.07-2.02), active cancer (OR, 2.15; 95% CI, 1.35-3.43), and the presence of hypoxemia (Pao2:Fio2<100 vs ≥300 mm Hg: OR, 2.94; 95% CI, 2.11-4.08), liver dysfunction (liver Sequential Organ Failure Assessment score of 2 vs 0: OR, 2.61; 95% CI, 1.30-5.25), and kidney dysfunction (renal Sequential Organ Failure Assessment score of 4 vs 0: OR, 2.43; 95% CI, 1.46-4.05) at ICU admission. Patients admitted to hospitals with fewer ICU beds had a higher risk of death (<50 vs ≥100 ICU beds: OR, 3.28; 95% CI, 2.16-4.99). Hospitals varied considerably in the risk-adjusted proportion of patients who died (range, 6.6%-80.8%) and in the percentage of patients who received hydroxychloroquine, tocilizumab, and other treatments and supportive therapies.
Conclusions and relevance: This study identified demographic, clinical, and hospital-level risk factors that may be associated with death in critically ill patients with COVID-19 and can facilitate the identification of medications and supportive therapies to improve outcomes.
. 2020 Jul 15.
doi: 10.1001/jamainternmed.2020.3596. Online ahead of print.
Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US
Shruti Gupta[SUP] 1 [/SUP], Salim S Hayek[SUP] 2 [/SUP], Wei Wang[SUP] 3 [/SUP], Lili Chan[SUP] 4 [/SUP], Kusum S Mathews[SUP] 5 6 [/SUP], Michal L Melamed[SUP] 7 [/SUP], Samantha K Brenner[SUP] 8 9 [/SUP], Amanda Leonberg-Yoo[SUP] 10 [/SUP], Edward J Schenck[SUP] 11 [/SUP], Jared Radbel[SUP] 12 [/SUP], Jochen Reiser[SUP] 13 [/SUP], Anip Bansal[SUP] 14 [/SUP], Anand Srivastava[SUP] 15 [/SUP], Yan Zhou[SUP] 16 [/SUP], Anne Sutherland[SUP] 17 [/SUP], Adam Green[SUP] 18 [/SUP], Alexandre M Shehata[SUP] 19 [/SUP], Nitender Goyal[SUP] 20 [/SUP], Anitha Vijayan[SUP] 21 [/SUP], Juan Carlos Q Velez[SUP] 22 23 [/SUP], Shahzad Shaefi[SUP] 24 [/SUP], Chirag R Parikh[SUP] 25 [/SUP], Justin Arunthamakun[SUP] 26 [/SUP], Ambarish M Athavale[SUP] 27 [/SUP], Allon N Friedman[SUP] 28 [/SUP], Samuel A P Short[SUP] 29 [/SUP], Zoe A Kibbelaar[SUP] 30 [/SUP], Samah Abu Omar[SUP] 1 [/SUP], Andrew J Admon[SUP] 31 32 [/SUP], John P Donnelly[SUP] 32 33 [/SUP], Hayley B Gershengorn[SUP] 34 35 [/SUP], Miguel A Hern?n[SUP] 36 37 38 [/SUP], Matthew W Semler[SUP] 39 [/SUP], David E Leaf[SUP] 1 [/SUP], STOP-COVID Investigators
Affiliations
- PMID: 32667668
- DOI: 10.1001/jamainternmed.2020.3596
Abstract
Importance: The US is currently an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet few national data are available on patient characteristics, treatment, and outcomes of critical illness from COVID-19.
Objectives: To assess factors associated with death and to examine interhospital variation in treatment and outcomes for patients with COVID-19.
Design, setting, and participants: This multicenter cohort study assessed 2215 adults with laboratory-confirmed COVID-19 who were admitted to intensive care units (ICUs) at 65 hospitals across the US from March 4 to April 4, 2020.
Exposures: Patient-level data, including demographics, comorbidities, and organ dysfunction, and hospital characteristics, including number of ICU beds.
Main outcomes and measures: The primary outcome was 28-day in-hospital mortality. Multilevel logistic regression was used to evaluate factors associated with death and to examine interhospital variation in treatment and outcomes.
Results: A total of 2215 patients (mean [SD] age, 60.5 [14.5] years; 1436 [64.8%] male; 1738 [78.5%] with at least 1 chronic comorbidity) were included in the study. At 28 days after ICU admission, 784 patients (35.4%) had died, 824 (37.2%) were discharged, and 607 (27.4%) remained hospitalized. At the end of study follow-up (median, 16 days; interquartile range, 8-28 days), 875 patients (39.5%) had died, 1203 (54.3%) were discharged, and 137 (6.2%) remained hospitalized. Factors independently associated with death included older age (≥80 vs <40 years of age: odds ratio [OR], 11.15; 95% CI, 6.19-20.06), male sex (OR, 1.50; 95% CI, 1.19-1.90), higher body mass index (≥40 vs <25: OR, 1.51; 95% CI, 1.01-2.25), coronary artery disease (OR, 1.47; 95% CI, 1.07-2.02), active cancer (OR, 2.15; 95% CI, 1.35-3.43), and the presence of hypoxemia (Pao2:Fio2<100 vs ≥300 mm Hg: OR, 2.94; 95% CI, 2.11-4.08), liver dysfunction (liver Sequential Organ Failure Assessment score of 2 vs 0: OR, 2.61; 95% CI, 1.30-5.25), and kidney dysfunction (renal Sequential Organ Failure Assessment score of 4 vs 0: OR, 2.43; 95% CI, 1.46-4.05) at ICU admission. Patients admitted to hospitals with fewer ICU beds had a higher risk of death (<50 vs ≥100 ICU beds: OR, 3.28; 95% CI, 2.16-4.99). Hospitals varied considerably in the risk-adjusted proportion of patients who died (range, 6.6%-80.8%) and in the percentage of patients who received hydroxychloroquine, tocilizumab, and other treatments and supportive therapies.
Conclusions and relevance: This study identified demographic, clinical, and hospital-level risk factors that may be associated with death in critically ill patients with COVID-19 and can facilitate the identification of medications and supportive therapies to improve outcomes.