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Published on: September 24, 2020
Intensive care unit burden is associated with increased mortality in critically ill COVID-19 patients
Ingrid Didriksson1,2, Märta Leffler1,2, Martin Spångfors1,3
1Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden.
Insights
In critically ill COVID-19 patients, 90-day mortality was 39%, increasing significantly with age over 60. Intensive care unit (ICU) burden also raised mortality risk, while high body mass index (BMI) did not. Longer ICU stays correlated with poorer functional outcomes.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Traditional intensive care unit (ICU) outcome prediction models are inadequate for COVID-19 patients.
- Severe COVID-19 presents unique challenges for predicting mortality and functional recovery.
- A comprehensive study is needed to identify key factors influencing outcomes in critically ill COVID-19 patients.
Purpose of the Study:
- To identify predictors of 90-day mortality in critically ill COVID-19 patients.
- To assess factors influencing functional outcomes at 90 days post-ICU admission.
- To evaluate the impact of ICU burden on patient mortality.
Main Methods:
- Prospective, multicentre cohort study of 498 critically ill COVID-19 patients across six ICUs in Sweden (May 2020-May 2021).
- Data collection included demographics, clinical information, and ICU burden (total ICU-treated COVID-19 patients on admission).
- Functional outcome assessed at 90 days using the Glasgow Outcome Scale-Extended (GOSE); primary outcome was 90-day mortality.
Main Results:
- 39% 90-day mortality observed; mortality increased significantly in patients aged 60 and older.
- Increasing ICU burden was independently associated with a two-fold increase in mortality.
- Factors independently predicting mortality included age, ICU burden, smoking status, cortisone use, high PaCO2, and inflammatory markers; high BMI was not associated with mortality.
Conclusions:
- Critically ill COVID-19 patients face a substantial 90-day mortality risk, particularly older individuals.
- ICU burden is a significant independent predictor of mortality, highlighting system-level impacts.
- Longer ICU stays are linked to unfavorable functional outcomes, emphasizing the need for efficient resource utilization and patient management.
Background:
Traditional models to predict intensive care outcomes do not perform well in COVID-19. We undertook a comprehensive study of factors affecting mortality and functional outcome after severe COVID-19.
Methods:
In this prospective multicentre cohort study, we enrolled laboratory-confirmed, critically ill COVID-19 patients at six ICUs in the Skåne Region, Sweden, between May 11, 2020, and May 10, 2021. Demographics and clinical data were collected. ICU burden was defined as the total number of ICU-treated COVID-19 patients in the region on admission. Surviving patients had a follow-up at 90 days for assessment of functional outcome using the Glasgow Outcome Scale-Extended (GOSE), an ordinal scale (1-8) with GOSE ≥5 representing a favourable outcome. The primary outcome was 90-day mortality; the secondary outcome was functional outcome at 90 days.
Results:
Among 498 included patients, 74% were male with a median age of 66 years and a median body mass index (BMI) of 30 kg/m2 . Invasive mechanical ventilation was employed in 72%. Mortality in the ICU, in-hospital and at 90 days was 30%, 38% and 39%, respectively. Mortality increased markedly at age 60 and older. Increasing ICU burden was independently associated with a two-fold increase in mortality. Higher BMI was not associated with increased mortality. Besides age and ICU burden, smoking status, cortisone use, Pa CO2 >7 kPa, and inflammatory markers on admission were independent factors of 90-day mortality. Lower GOSE at 90 days was associated with a longer stay in the ICU.
Conclusion:
In critically ill COVID-19 patients, the 90-day mortality was 39% and increased considerably at age 60 or older. The ICU burden was associated with mortality, whereas a high BMI was not. A longer stay in the ICU was associated with unfavourable functional outcomes at 90 days.
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