Outcomes of Patients With Coronavirus Disease 2019 Receiving Organ Support Therapies: The International Viral Infection and Respiratory Illness Universal Study Registry. Issue 3 (28th January 2021)

• Record Type: Journal Article
• Authors: Domecq, Juan Pablo; Lal, Amos; Sheldrick, Christopher R.; Kumar, Vishakha K.; Boman, Karen; Bolesta, Scott; Bansal, Vikas; Harhay, Michael O.; Garcia, Michael A.; Kaufman, Margit; Danesh, Valerie; Cheruku, Sreekanth; Banner-Goodspeed, Valerie M.; Anderson, Harry L.; Milligan, Patrick S.; Denson, Joshua L.; St. Hill, Catherine A.; Dodd, Kenneth W.; Martin, Greg S.; Gajic, Ognjen; Walkey, Allan J.; Kashyap, Rahul
• Is Part Of: Critical care medicine. Volume 49:Issue 3(2021)
• Page Start: 437
• Page End: 448
• Publication Date: 2021-01-28
• Subjects: big data -- coronavirus disease 2019 -- intensive care unit -- organ failure -- patients -- severe acute respiratory syndrome coronavirus 2 -- Viral Infection and Respiratory Illness University Study; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000004879
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Supplemental Digital Content is available in the text. Abstract : OBJECTIVES: To describe the outcomes of hospitalized patients in a multicenter, international coronavirus disease 2019 registry. DESIGN: Cross-sectional observational study including coronavirus disease 2019 patients hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection between February 15, 2020, and November 30, 2020, according to age and type of organ support therapies. SETTING: About 168 hospitals in 16 countries within the Society of Critical Care Medicine's Discovery Viral Infection and Respiratory Illness University Study coronavirus disease 2019 registry. PATIENTS: Adult hospitalized coronavirus disease 2019 patients who did and did not require various types and combinations of organ support (mechanical ventilation, renal replacement therapy, vasopressors, and extracorporeal membrane oxygenation). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcome was hospital mortality. Secondary outcomes were discharge home with or without assistance and hospital length of stay. Risk-adjusted variation in hospital mortality for patients receiving invasive mechanical ventilation was assessed by using multilevel models with hospitals as a random effect, adjusted for age, race/ethnicity, sex, and comorbidities. Among 20, 608 patients with coronavirus disease 2019, the mean (± sd ) age was 60.5 (±17), 11, 1887 (54.3%) were men, 8, 745 (42.4%) were admitted to the ICU, and 3, 906 (19%) died in the hospital. Hospital mortality was 8.2% for patients receiving no organ support ( n = 15, 001). The most common organ support therapy was invasive mechanical ventilation ( n = 5, 005; 24.3%), with a hospital mortality of 49.8%. Mortality ranged from 40.8% among patients receiving only invasive mechanical ventilation ( n =1, 749) to 71.6% for patients receiving invasive mechanical ventilation, vasoactive drugs, and new renal replacement therapy ( n = 655). Mortality was 39% for patients receiving extracorporeal membrane oxygenation ( n = 389). Rates of discharge home ranged from 73.5% for patients who did not require organ support therapies to 29.8% for patients who only received invasive mechanical ventilation, and 8.8% for invasive mechanical ventilation, vasoactive drugs, and renal replacement; 10.8% of patients older than 74 years who received invasive mechanical ventilation were discharged home. Median hospital length of stay for patients on mechanical ventilation was 17.1 days (9.7-28 d). Adjusted interhospital variation in mortality among patients receiving invasive mechanical ventilation was large (median odds ratio 1.69). CONCLUSIONS: Coronavirus disease 2019 prognosis varies by age and level of organ support. Interhospital variation in mortality of mechanically ventilated patients was not explained by patient characteristics and requires further evaluation.