Non-COVID-19 intensive care admissions during the pandemic: a multinational registry-based study

Area of Science:

• Critical care medicine
• Global health
• Epidemiology

Background:

• The COVID-19 pandemic led to significant critical care admissions worldwide.
• International data on the pandemic's impact on non-COVID-19 intensive care unit (ICU) patients is limited.
• Understanding these effects is crucial for global healthcare preparedness.

Purpose of the Study:

• To assess the impact of the COVID-19 pandemic on mortality rates for non-COVID-19 patients requiring intensive care.
• To compare outcomes between 2019 (pre-pandemic) and 2020 (pandemic year) across different country income levels.
• To identify potential factors contributing to observed mortality trends.

Main Methods:

• An international retrospective cohort study was conducted using data from 11 national clinical quality registries across 15 countries.
• Non-COVID-19 admissions in 2020 were compared to all admissions in 2019.
• Primary outcome was ICU mortality; secondary outcomes included in-hospital mortality and standardized mortality ratio (SMR), stratified by country income.

Main Results:

• Non-COVID-19 ICU mortality increased from 9.3% in 2019 to 10.4% in 2020 (OR=1.15).
• Mortality significantly increased in middle-income countries (OR 1.25) but decreased in high-income countries (OR=0.96).
• Trends in hospital mortality and SMR aligned with ICU findings; COVID-19 burden did not solely explain these changes.

Conclusions:

• The COVID-19 pandemic exacerbated ICU mortality disparities among non-COVID-19 patients globally.
• Increased mortality in middle-income countries versus decreased mortality in high-income countries suggests significant healthcare inequities.
• Factors such as healthcare spending, pandemic response policies, and ICU strain likely contribute to these divergent outcomes.