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Outcomes Associated With Intensive Care and Organ Support Among Patients With COVID-19: A Systematic Review and
Sahar Leazer1,2, Jacob Collen1, Karl Alcover1
1Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA.
Critical care outcomes for patients with coronavirus disease 2019 (COVID-19) improved over time. Intensive care unit (ICU) mortality rates were higher for patients admitted earlier in the pandemic, emphasizing the need for contextual outcome evaluation.
Area of Science:
- Critical care medicine
- Infectious disease epidemiology
- Health services research
Background:
- Accurate accounting of COVID-19 critical care outcomes is vital for healthcare delivery.
- Understanding variations in outcomes based on study completeness and admission timing is crucial.
Approach:
- Systematic review and meta-analysis of 145 observational studies (60,357 patients) published from December 2019 to December 2020.
- Searched PubMed, Embase, and Cochrane databases for studies reporting ICU, mechanical ventilation (MV), renal replacement therapy (RRT), and extracorporeal membrane oxygenation (ECMO) mortality.
- Performed subgroup analyses based on admission end date and data completeness.
Key Points:
- Overall ICU case fatality was 34.0%, MV 47.9%, RRT 58.7%, and ECMO 43.3%.
- No significant difference in outcomes was found between studies with complete versus incomplete follow-up.
- Case fatality rates for ICU, MV, and RRT were significantly higher in studies with patients admitted before April 2020.
Conclusions:
- COVID-19 critical care outcomes have improved since the pandemic's onset.
- Evaluating ICU outcomes requires consideration of study quality, data completeness, and time period.
- Contextual evaluation is essential for accurate reporting and guiding mortality predictions.
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