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COVID-19 critical illness in Sweden: characteristics and outcomes at a national population level

Johan Mårtensson^1,2, Lars Engerström^3,4,5, Sten Walther^3,4,5

¹Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.

Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine

|December 4, 2023

Insights

This study found that older age, pre-existing chronic illnesses, and severe acute illness were associated with higher 30-day mortality in intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19).

Area of Science:

Critical Care Medicine
Epidemiology
Infectious Diseases

Background:

Limited data exist on outcomes for severely ill patients during the COVID-19 pandemic.
Understanding factors associated with mortality in intensive care unit (ICU) patients is crucial.

Purpose of the Study:

To examine the association between patient characteristics and 30-day mortality among COVID-19 patients admitted to the ICU.
To identify risk factors for mortality in critically ill COVID-19 patients.

Main Methods:

Population-based cohort study including 604 consecutive COVID-19 patients admitted to Swedish ICUs between March 6 and April 5, 2020.
Primary outcome was 30-day mortality after ICU admission.
Multivariable Cox regression analysis was used to identify associated factors.

Main Results:

The 30-day mortality rate was 32.6%.
Factors associated with increased 30-day mortality included older age (HR 1.06 per year), presence of comorbidities (HR 1.80), chronic obstructive pulmonary disease or asthma (HR 1.68), hypertension (HR 1.41), and acute illness severity (SAPS 3, HR 1.06).
The majority of patients (76%) were male, with a median age of 61 years.

Conclusions:

Older age, pre-existing chronic illnesses (including COPD, asthma, and hypertension), and higher acute illness severity are significantly associated with 30-day mortality in critically ill COVID-19 patients.
These findings highlight the importance of considering patient characteristics when managing severe COVID-19 cases in the ICU.

Read full analysis

Abstract:

Objective: During the coronavirus disease 2019 (COVID-19) pandemic, baseline demographics and comorbidities of patients with COVID-19 have been presented, but there are limited data on outcomes of severely ill patients. We aimed to examine the association between patient characteristics and 30-day mortality among patients with COVID-19 treated in the intensive care unit (ICU). Design: Population-based cohort study. Setting: ICUs in Sweden. Participants: All consecutive patients with COVID-19 admitted to Swedish ICUs from 6 March to 5 April 2020. Main outcome measures: The primary outcome was 30-day mortality after ICU admission. Patient demographics, comorbidities and clinical characteristics were also retrieved. Results: A total of 604 patients were included. The median age was 61 years (interquartile range [IQR], 52-70 years) and 458 patients (76%) were males. The most common comorbidities were hypertension (35.9%) and diabetes (25.7%), whereas 36.4% of patients had no comorbidities. Median Simplified Acute Physiology Score (SAPS) 3 was 53 (IQR, 46-60). Of 573 patients with available respiratory support data, 487 (85.0%) received invasive mechanical ventilation. Among 518 patients with available data, 117 (22.6%) received renal replacement therapy. Median length of stay was 13 days (IQR, 6-20 days). Mortality at 30 days was 32.6%. In the multivariable Cox regression model, age (hazard ratio [HR] 1.06; 95% CI, 1.04-1.07 per year), the presence of one or more comorbidities (HR, 1.80; 95% CI, 1.20-2.68), chronic obstructive pulmonary disease or asthma (HR, 1.68; 95% CI, 1.12-2.50), hypertension (HR, 1.41; 95% CI, 1.01-1.99), and acute illness severity (SAPS 3 excluding age and comorbidity) (HR, 1.06; 95% CI, 1.04-1.09) were associated with 30-day mortality. Conclusions: This population-based cohort study presents 30-day mortality of 604 ICU patients with COVID-19. The higher mortality was explained by older age, the presence chronic illness, and acute illness severity.

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