Abstract
Due to the large number of patients with severe coronavirus disease 2019 (COVID-19), many were treated outside the traditional walls of the intensive care unit (ICU), and in many cases, by personnel who were not trained in critical care. The clinical characteristics and the relative impact of caring for severe COVID-19 patients outside the ICU is unknown. This was a multinational, multicentre, prospective cohort study embedded in the International Severe Acute Respiratory and Emerging Infection Consortium World Health Organization COVID-19 platform. Severe COVID-19 patients were identified as those admitted to an ICU and/or those treated with one of the following treatments: invasive or noninvasive mechanical ventilation, high-flow nasal cannula, inotropes or vasopressors. A logistic generalised additive model was used to compare clinical outcomes among patients admitted or not to the ICU. A total of 40 440 patients from 43 countries and six continents were included in this analysis. Severe COVID-19 patients were frequently male (62.9%), older adults (median (interquartile range (IQR), 67 (55–78) years), and with at least one comorbidity (63.2%). The overall median (IQR) length of hospital stay was 10 (5–19) days and was longer in patients admitted to an ICU than in those who were cared for outside the ICU (12 (6–23) days versus 8 (4–15) days, p<0.0001). The 28-day fatality ratio was lower in ICU-admitted patients (30.7% (5797 out of 18831) versus 39.0% (7532 out of 19 295), p<0.0001). Patients admitted to an ICU had a significantly lower probability of death than those who were not (adjusted OR 0.70, 95% CI 0.65–0.75; p<0.0001). Patients with severe COVID-19 admitted to an ICU had significantly lower 28-day fatality ratio than those cared for outside an ICU.
| Original language | English |
|---|---|
| Article number | 00552-2021 |
| Number of pages | 18 |
| Journal | ERJ Open Research |
| Volume | 8 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 2022 |
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In: ERJ Open Research, Vol. 8, No. 1, 00552-2021, 01.2022.
Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Clinical characteristics, risk factors and outcomes in patients with severe COVID-19 registered in the International Severe Acute Respiratory and Emerging Infection Consortium WHO clinical characterisation protocol
T2 - a prospective, multinational, multicentre, observational study
AU - Reyes, Luis Felipe
AU - Murthy, Srinivas
AU - Garcia-Gallo, Esteban
AU - Irvine, Mike
AU - Merson, Laura
AU - Martin-Loeches, Ignacio
AU - Rello, Jordi
AU - Taccone, Fabio S.
AU - Fowler, Robert A.
AU - Docherty, Annemarie B.
AU - Kartsonaki, Christiana
AU - Aragao, Irene
AU - Barrett, Peter W.
AU - Beane, Abigail
AU - Burrell, Aidan
AU - Cheng, Matthew Pellan
AU - Christian, Michael D.
AU - Cidade, Jose Pedro
AU - Citarella, Barbara Wanjiru
AU - Donnelly, Christl A.
AU - Fernandes, Susana M.
AU - French, Craig
AU - Haniffa, Rashan
AU - Harrison, Ewen M.
AU - Ho, Antonia Ying Wai
AU - Joseph, Mark
AU - Khan, Irfan
AU - Kho, Michelle E.
AU - Kildal, Anders Benjamin
AU - Kutsogiannis, Demetrios
AU - Lamontagne, François
AU - Lee, Todd C.
AU - Bassi, Gianluigi Li
AU - Revilla, Jose Wagner Lopez
AU - Marquis, Catherine
AU - Millar, Jonathan
AU - Neto, Raul
AU - Nichol, Alistair
AU - Parke, Rachael
AU - Pereira, Rui
AU - Poli, Sergio
AU - Povoa, Pedro
AU - Ramanathan, Kollengode
AU - Rewa, Oleksa
AU - Riera, Jordi
AU - Shrapnel, Sally
AU - Silva, Maria Joao
AU - Udy, Andrew
AU - Uyeki, Timothy
AU - Webb, Steve A.
AU - Wils, Evert Jan
AU - Rojek, Amanda
AU - Olliaro, Piero L.
AU - on behalf of the ISARIC Clinical Characterisation Group
N1 - Funding Information: This work uses data or material provided by patients and collected by the National Health Service as part of their care and support. The data/material used for this research were obtained from ISARIC4C. The COVID-19 Clinical Information Network data were collated by ISARIC4C Investigators. This work was possible due to the dedication and hard work of the Norwegian SARS-CoV-2 study team; the Groote Schuur Hospital COVID Intensive Care Unit Team, supported by the Groote Schuur nursing and University of Cape Town registrar bodies coordinated by the Division of Critical Care at the University of Cape Town; and supported by the COVID clinical management team, AIIMS, Rishikesh, India.The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of this manuscript. The corresponding author (LFR) had full access to all the data in the study and had final responsibility for the decision to submit for publication.Support statement: This work was supported by the UK Foreign, Commonwealth and Development Office and Wellcome (215091/Z/18/Z), the Bill and Melinda Gates Foundation (OPP1209135), Canadian Institutes of Health Research Coronavirus Rapid Research Funding Opportunity OV2170359, grants from Rapid European COVID-19 Emergency Response Research (Horizon 2020 project 101003589), the European Clinical Research Alliance on Infectious Diseases (965313), The Imperial National Institute for Health Research (NIHR) Biomedical Research Centre, and The Cambridge NIHR Biomedical Research Centre; and endorsed by the Irish Critical Care Clinical Trials Group, co-ordinated in Ireland by the Irish Critical Care Clinical Trials Network at University College Dublin and funded by the Health Research Board of Ireland (CTN-2014-12). Data and Material provision was supported by grants from: the NIHR (award CO-CIN-01), the Medical Research Council (grant MC_PC_19059), the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE) (award 200907), Wellcome Trust (Turtle, Lance-fellowship 205228/Z/16/Z), NIHR HPRU in Respiratory Infections at Imperial College London with PHE (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award IS-BRC-1215-20013), and NIHR Clinical Research Network providing infrastructure support. This work was by Research Council of Norway grant number 312780, and a philanthropic donation from Vivaldi Invest A/S owned by Jon Stephenson von Tetzchner. Funding information for this article has been deposited with the Crossref Funder Registry. Publisher Copyright: © The authors 2022.
PY - 2022/1
Y1 - 2022/1
N2 - Due to the large number of patients with severe coronavirus disease 2019 (COVID-19), many were treated outside the traditional walls of the intensive care unit (ICU), and in many cases, by personnel who were not trained in critical care. The clinical characteristics and the relative impact of caring for severe COVID-19 patients outside the ICU is unknown. This was a multinational, multicentre, prospective cohort study embedded in the International Severe Acute Respiratory and Emerging Infection Consortium World Health Organization COVID-19 platform. Severe COVID-19 patients were identified as those admitted to an ICU and/or those treated with one of the following treatments: invasive or noninvasive mechanical ventilation, high-flow nasal cannula, inotropes or vasopressors. A logistic generalised additive model was used to compare clinical outcomes among patients admitted or not to the ICU. A total of 40 440 patients from 43 countries and six continents were included in this analysis. Severe COVID-19 patients were frequently male (62.9%), older adults (median (interquartile range (IQR), 67 (55–78) years), and with at least one comorbidity (63.2%). The overall median (IQR) length of hospital stay was 10 (5–19) days and was longer in patients admitted to an ICU than in those who were cared for outside the ICU (12 (6–23) days versus 8 (4–15) days, p<0.0001). The 28-day fatality ratio was lower in ICU-admitted patients (30.7% (5797 out of 18831) versus 39.0% (7532 out of 19 295), p<0.0001). Patients admitted to an ICU had a significantly lower probability of death than those who were not (adjusted OR 0.70, 95% CI 0.65–0.75; p<0.0001). Patients with severe COVID-19 admitted to an ICU had significantly lower 28-day fatality ratio than those cared for outside an ICU.
AB - Due to the large number of patients with severe coronavirus disease 2019 (COVID-19), many were treated outside the traditional walls of the intensive care unit (ICU), and in many cases, by personnel who were not trained in critical care. The clinical characteristics and the relative impact of caring for severe COVID-19 patients outside the ICU is unknown. This was a multinational, multicentre, prospective cohort study embedded in the International Severe Acute Respiratory and Emerging Infection Consortium World Health Organization COVID-19 platform. Severe COVID-19 patients were identified as those admitted to an ICU and/or those treated with one of the following treatments: invasive or noninvasive mechanical ventilation, high-flow nasal cannula, inotropes or vasopressors. A logistic generalised additive model was used to compare clinical outcomes among patients admitted or not to the ICU. A total of 40 440 patients from 43 countries and six continents were included in this analysis. Severe COVID-19 patients were frequently male (62.9%), older adults (median (interquartile range (IQR), 67 (55–78) years), and with at least one comorbidity (63.2%). The overall median (IQR) length of hospital stay was 10 (5–19) days and was longer in patients admitted to an ICU than in those who were cared for outside the ICU (12 (6–23) days versus 8 (4–15) days, p<0.0001). The 28-day fatality ratio was lower in ICU-admitted patients (30.7% (5797 out of 18831) versus 39.0% (7532 out of 19 295), p<0.0001). Patients admitted to an ICU had a significantly lower probability of death than those who were not (adjusted OR 0.70, 95% CI 0.65–0.75; p<0.0001). Patients with severe COVID-19 admitted to an ICU had significantly lower 28-day fatality ratio than those cared for outside an ICU.
UR - http://www.scopus.com/inward/record.url?scp=85124879373&partnerID=8YFLogxK
U2 - 10.1183/23120541.00552-2021
DO - 10.1183/23120541.00552-2021
M3 - Article
C2 - 35169585
AN - SCOPUS:85124879373
SN - 2312-0541
VL - 8
JO - ERJ Open Research
JF - ERJ Open Research
IS - 1
M1 - 00552-2021
ER -