Shruti Gupta1, Salim S Hayek2, Wei Wang3, Lili Chan4, Kusum S Mathews5,6, Michal L Melamed7, Samantha K Brenner8,9, Amanda Leonberg-Yoo10, Edward J Schenck11, Jared Radbel12, Jochen Reiser13, Anip Bansal14, Anand Srivastava15, Yan Zhou16, Anne Sutherland17, Adam Green18, Alexandre M Shehata19, Nitender Goyal20, Anitha Vijayan21, Juan Carlos Q Velez22,23, Shahzad Shaefi24, Chirag R Parikh25, Justin Arunthamakun26, Ambarish M Athavale27, Allon N Friedman28, Samuel A P Short29, Zoe A Kibbelaar30, Samah Abu Omar1, Andrew J Admon31,32, John P Donnelly32,33, Hayley B Gershengorn34,35, Miguel A Hernán36,37,38, Matthew W Semler39, David E Leaf1. 1. Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 2. Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor. 3. Department of Medicine, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts. 4. Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 5. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 6. Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 7. Montefiore Medical Center, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York. 8. Department of Internal Medicine, Hackensack Meridian School of Medicine at Seton Hall, Nutley, New Jersey. 9. Heart and Vascular Hospital, Hackensack Meridian Health Hackensack University Medical Center, Hackensack, New Jersey. 10. Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 11. Divison of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York. 12. Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. 13. Department of Medicine, Rush University Medical Center, Chicago, Illinois. 14. Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora. 15. Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine. 16. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee. 17. Division of Pulmonary and Critical Care Medicine, Rutgers New Jersey Medical School, Newark. 18. Cooper University Health Care, Camden, New Jersey. 19. Department of Medicine, Hackensack Meridian Health Mountainside Medical Center, Glen Ridge, New Jersey. 20. Division of Nephrology, Tufts Medical Center, Boston, Massachusetts. 21. Division of Nephrology, Washington University in St Louis, St Louis, Missouri. 22. Department of Nephrology, Ochsner Health System, New Orleans, Louisiana. 23. Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia. 24. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 25. Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland. 26. Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas. 27. Division of Nephrology, Cook County Health, Chicago, Illinois. 28. Department of Medicine, Indiana University School of Medicine, Indianapolis. 29. Larner College of Medicine, University of Vermont, Burlington. 30. Renal Section, Boston Medical Center, Boston, Massachusetts. 31. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor. 32. Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor. 33. Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor. 34. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida. 35. Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York. 36. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 37. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 38. Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Boston, Massachusetts. 39. Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Abstract
Importance: The US is currently an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet few national data are available on patient characteristics, treatment, and outcomes of critical illness from COVID-19. Objectives: To assess factors associated with death and to examine interhospital variation in treatment and outcomes for patients with COVID-19. Design, Setting, and Participants: This multicenter cohort study assessed 2215 adults with laboratory-confirmed COVID-19 who were admitted to intensive care units (ICUs) at 65 hospitals across the US from March 4 to April 4, 2020. Exposures: Patient-level data, including demographics, comorbidities, and organ dysfunction, and hospital characteristics, including number of ICU beds. Main Outcomes and Measures: The primary outcome was 28-day in-hospital mortality. Multilevel logistic regression was used to evaluate factors associated with death and to examine interhospital variation in treatment and outcomes. Results: A total of 2215 patients (mean [SD] age, 60.5 [14.5] years; 1436 [64.8%] male; 1738 [78.5%] with at least 1 chronic comorbidity) were included in the study. At 28 days after ICU admission, 784 patients (35.4%) had died, 824 (37.2%) were discharged, and 607 (27.4%) remained hospitalized. At the end of study follow-up (median, 16 days; interquartile range, 8-28 days), 875 patients (39.5%) had died, 1203 (54.3%) were discharged, and 137 (6.2%) remained hospitalized. Factors independently associated with death included older age (≥80 vs <40 years of age: odds ratio [OR], 11.15; 95% CI, 6.19-20.06), male sex (OR, 1.50; 95% CI, 1.19-1.90), higher body mass index (≥40 vs <25: OR, 1.51; 95% CI, 1.01-2.25), coronary artery disease (OR, 1.47; 95% CI, 1.07-2.02), active cancer (OR, 2.15; 95% CI, 1.35-3.43), and the presence of hypoxemia (Pao2:Fio2<100 vs ≥300 mm Hg: OR, 2.94; 95% CI, 2.11-4.08), liver dysfunction (liver Sequential Organ Failure Assessment score of 2-4 vs 0: OR, 2.61; 95% CI, 1.30-5.25), and kidney dysfunction (renal Sequential Organ Failure Assessment score of 4 vs 0: OR, 2.43; 95% CI, 1.46-4.05) at ICU admission. Patients admitted to hospitals with fewer ICU beds had a higher risk of death (<50 vs ≥100 ICU beds: OR, 3.28; 95% CI, 2.16-4.99). Hospitals varied considerably in the risk-adjusted proportion of patients who died (range, 6.6%-80.8%) and in the percentage of patients who received hydroxychloroquine, tocilizumab, and other treatments and supportive therapies. Conclusions and Relevance: This study identified demographic, clinical, and hospital-level risk factors that may be associated with death in critically ill patients with COVID-19 and can facilitate the identification of medications and supportive therapies to improve outcomes.
Importance: The US is currently an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet few national data are available on patient characteristics, treatment, and outcomes of critical illness from COVID-19. Objectives: To assess factors associated with death and to examine interhospital variation in treatment and outcomes for patients with COVID-19. Design, Setting, and Participants: This multicenter cohort study assessed 2215 adults with laboratory-confirmed COVID-19 who were admitted to intensive care units (ICUs) at 65 hospitals across the US from March 4 to April 4, 2020. Exposures: Patient-level data, including demographics, comorbidities, and organ dysfunction, and hospital characteristics, including number of ICU beds. Main Outcomes and Measures: The primary outcome was 28-day in-hospital mortality. Multilevel logistic regression was used to evaluate factors associated with death and to examine interhospital variation in treatment and outcomes. Results: A total of 2215 patients (mean [SD] age, 60.5 [14.5] years; 1436 [64.8%] male; 1738 [78.5%] with at least 1 chronic comorbidity) were included in the study. At 28 days after ICU admission, 784 patients (35.4%) had died, 824 (37.2%) were discharged, and 607 (27.4%) remained hospitalized. At the end of study follow-up (median, 16 days; interquartile range, 8-28 days), 875 patients (39.5%) had died, 1203 (54.3%) were discharged, and 137 (6.2%) remained hospitalized. Factors independently associated with death included older age (≥80 vs <40 years of age: odds ratio [OR], 11.15; 95% CI, 6.19-20.06), male sex (OR, 1.50; 95% CI, 1.19-1.90), higher body mass index (≥40 vs <25: OR, 1.51; 95% CI, 1.01-2.25), coronary artery disease (OR, 1.47; 95% CI, 1.07-2.02), active cancer (OR, 2.15; 95% CI, 1.35-3.43), and the presence of hypoxemia (Pao2:Fio2<100 vs ≥300 mm Hg: OR, 2.94; 95% CI, 2.11-4.08), liver dysfunction (liver Sequential Organ Failure Assessment score of 2-4 vs 0: OR, 2.61; 95% CI, 1.30-5.25), and kidney dysfunction (renal Sequential Organ Failure Assessment score of 4 vs 0: OR, 2.43; 95% CI, 1.46-4.05) at ICU admission. Patients admitted to hospitals with fewer ICU beds had a higher risk of death (<50 vs ≥100 ICU beds: OR, 3.28; 95% CI, 2.16-4.99). Hospitals varied considerably in the risk-adjusted proportion of patients who died (range, 6.6%-80.8%) and in the percentage of patients who received hydroxychloroquine, tocilizumab, and other treatments and supportive therapies. Conclusions and Relevance: This study identified demographic, clinical, and hospital-level risk factors that may be associated with death in critically illpatients with COVID-19 and can facilitate the identification of medications and supportive therapies to improve outcomes.
Authors: Kusum S Mathews; Howard Soh; Shahzad Shaefi; Wei Wang; Sonali Bose; Steven Coca; Shruti Gupta; Salim S Hayek; Anand Srivastava; Samantha K Brenner; Jared Radbel; Adam Green; Anne Sutherland; Amanda Leonberg-Yoo; Alexandre Shehata; Edward J Schenck; Samuel A P Short; Miguel A Hernán; Lili Chan; David E Leaf Journal: Crit Care Med Date: 2021-07-01 Impact factor: 7.598
Authors: Samuel A P Short; Shruti Gupta; Samantha K Brenner; Salim S Hayek; Anand Srivastava; Shahzad Shaefi; Harkarandeep Singh; Benjamin Wu; Aranya Bagchi; Hanny Al-Samkari; Rajany Dy; Katherine Wilkinson; Neil A Zakai; David E Leaf Journal: Crit Care Med Date: 2021-05-01 Impact factor: 7.598
Authors: Brian L Block; Thomas M Martin; W John Boscardin; Kenneth E Covinsky; Michele Mourad; Lissy L Hu; Alexander K Smith Journal: J Hosp Med Date: 2021-04 Impact factor: 2.960
Authors: Abhishek Bhardwaj; Mahmoud Alwakeel; Talha Saleem; Saira Afzal; Sura Alqaisi; Aisha R Saand; Hanan Al Najjar; Lori Griffiths; Xiaozhen Han; Xiaofeng Wang; Silvia Perez-Protto; Benjamin S Abella; David F Gaieski; Abhijit Duggal; Francois Abi Fadel Journal: Crit Care Explor Date: 2021-05-14
Authors: A Yacobitti; L Otero; V Doldan Arrubarrena; J Arano; S Lage; M Silberman; M Zubieta; I Erbetta; P Danei; G Baeck; V Vallejos; F Cavalli; N Calderón; M Di Gregorio; V Hernandez; D Bruno; B Rodera; I Macherett; M Parisi; M Gallastegui; A Paz; R Bernardi; S Azcárate; A Hraste; I Caridi; L Boechi; P Salgado; S Kochen Journal: Sci Rep Date: 2021-05-06 Impact factor: 4.379
Authors: Alexi Vasbinder; Elizabeth Anderson; Husam Shadid; Hanna Berlin; Michael Pan; Tariq U Azam; Ibrahim Khaleel; Kishan Padalia; Chelsea Meloche; Patrick O'Hayer; Erinleigh Michaud; Tonimarie Catalan; Rafey Feroze; Pennelope Blakely; Christopher Launius; Yiyuan Huang; Lili Zhao; Lynn Ang; Monica Mikhael; Kara Mizokami-Stout; Subramaniam Pennathur; Matthias Kretzler; Sven H Loosen; Athanasios Chalkias; Frank Tacke; Evangelos J Giamarellos-Bourboulis; Jochen Reiser; Jesper Eugen-Olsen; Eva L Feldman; Rodica Pop-Busui; Salim S Hayek; Salim S Hayek; Pennelope Blakely; Hanna Berlin; Tariq U Azam; Husam Shadid; Michael Pan; Patrick O'Hayer; Chelsea Meloche; Rafey Feroze; Kishan J Padalia; Elizabeth Anderson; Danny Perry; Abbas Bitar; Rayan Kaakati; Yiyuan Huang; Lili Zhao; Jochen Reiser; Beata Samelko; Alex Hlepas; Priya P Patel; Xuexiang Wang; Jesper Eugen-Olsen; Izzet Altintas; Marius Stauning; Morten Baltzer Houlind; Mette B Lindstrøm; Hejdi Gamst-Jensen; Line Jee Hartmann; Jan O Nehlin; Thomas Kallemose; Imran Parvaiz; Christian Rasmussen; Ove Andersen; Jens Tingleff; Evangelos J Giamarellos-Bourboulis; Maria-Evangelia Adami; Nicky Solomonidi; Maria Tsilika; Maria Saridaki; Vasileios Lekakis; Sven H Loosen; Tom Luedde; Verena Keitel; Athanasios Chalkias; Eleni Arnaoutoglou; Ioannis Pantazopoulos; Eleni Laou; Konstantina Kolonia; Anargyros Skoulakis; Frank Tacke; Pinkus Tober-Lau; Raphael Mohr; Florian Kurth; Leif Erik Sander; Christoph Jochum Journal: Diabetes Care Date: 2022-03-01 Impact factor: 19.112
Authors: Shruti Gupta; Wei Wang; Salim S Hayek; Lili Chan; Kusum S Mathews; Michal L Melamed; Samantha K Brenner; Amanda Leonberg-Yoo; Edward J Schenck; Jared Radbel; Jochen Reiser; Anip Bansal; Anand Srivastava; Yan Zhou; Diana Finkel; Adam Green; Mary Mallappallil; Anthony J Faugno; Jingjing Zhang; Juan Carlos Q Velez; Shahzad Shaefi; Chirag R Parikh; David M Charytan; Ambarish M Athavale; Allon N Friedman; Roberta E Redfern; Samuel A P Short; Simon Correa; Kapil K Pokharel; Andrew J Admon; John P Donnelly; Hayley B Gershengorn; David J Douin; Matthew W Semler; Miguel A Hernán; David E Leaf Journal: JAMA Intern Med Date: 2021-01-01 Impact factor: 21.873