Characteristics and outcomes of patients with COVID‐19 admitted to ICU in a tertiary hospital in Stockholm, Sweden

Larsson, Emma; Brattström, Olof; Agvald-Öhman, Christina; Grip, Jonathan; Jalde, Francesca Campoccia; Strålin, Kristoffer; Nauclér, Pontus; Oldner, Anders; Konrad, David; Persson, B.; Eriksson, Lars; Mårtensson, Johan

doi:10.1111/aas.13694

Cited by 55 publications

(78 citation statements)

References 8 publications

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“…Twenty one reports were from the United States, 7 , 8 , 10 , 19 , 20 , 21 , 22 , 26 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 17 reports were from China, 11 , 12 , 25 , 28 , 30 , 33 , 34 , 35 , 36 , 37 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 12 from Europe 18 , 29 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , one each from India 67 , Bahrain 68 and South Korea 27 , and one report 69 included multiple cities from the United States and Europe. The studies included 30,657 hospitalized patients, of whom 12,800 (41.8%) were women.…”

Section: Resultsmentioning

confidence: 99%

The Prevalence of Acute Kidney Injury in Patients Hospitalized With COVID-19 Infection: A Systematic Review and Meta-analysis

et al. 2021

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Rationale and Objective Coronavirus disease 2019 (COVID-19) may be associated with high rates of AKI and kidney replacement therapy (KRT), potentially overwhelming healthcare resources. Our objective was to determine the pooled prevalence of AKI and KRT among hospitalized patients with COVID-19. Study Design Systematic Review and Meta-analysis Data sources Medline, Embase, the Cochrane Library, and a registry of preprinted studies, published up to 14 Oct 2020. Study Selection Eligible studies reported the prevalence of AKI in hospitalized patients with COVID-19 according to the Kidney Disease Improving Global Outcomes (KDIGO) definition. Data Extraction and Synthesis We extracted data on patient characteristics, the proportion of patients developing AKI and commencing KRT, important clinical outcomes (discharge from hospital, ongoing hospitalization and death), and risk of bias. Outcomes and Measures We calculated the pooled prevalence of AKI and receipt of KRT, along with 95% confidence intervals (CI) using a random effects model. We performed subgroup analysis based on admission to an intensive care unit (ICU). Results Of 2,711 records reviewed, we included 53 published and 1 preprint study in the analysis, which comprised 30,657 hospitalized patients with COVID-19. Data on AKI were available for 30,639 patients (n=54 studies), and the receipt of KRT for 27,525 patients (n=48 studies). The pooled prevalence of AKI was 28% (95% CI 22% to 34%; I 2 =99%), and the pooled prevalence of KRT was 9% (95% CI 7% to 11%; I 2 =97). The pooled prevalence of AKI among patients admitted to the ICU was 46% (95% CI 35% to 57%, I 2 =99%) and 19% of all ICU patients with COVID-19 (95% CI 15% to 22%; I 2 =88%) commenced KRT. Limitations There was significant heterogeneity among the included studies which remained unaccounted for in sub-group analysis. Conclusions AKI complicated the course of nearly 1 in 3 patients hospitalized with COVID-19. The risk of AKI was higher in critically ill patients with a substantial number receiving KRT at rates higher than the general ICU population. Since COVID-19 will be a public health threat for the foreseeable future, these estimates should help guide KRT resource planning.

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Section: Resultsmentioning

confidence: 99%

The Prevalence of Acute Kidney Injury in Patients Hospitalized With COVID-19 Infection: A Systematic Review and Meta-analysis

et al. 2021

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“…They may have higher intubation, ICU admission, and death, and there are reported variations between outcomes of COVID-19 between hospitals and also countries. While this limitation apparently can falsely reduce the rate of serious outcomes from COVID-19, overall, this possibility gets diluted by the inclusion of a big number HCOs providing care to different communities [ [37] , [38] , [39] , [40] ].…”

Section: Discussionmentioning

confidence: 99%

Immunosuppression in chronic autoimmune neurological disorders during the COVID-19 pandemic

Kovvuru

Nalleballe

Onteddu

et al. 2021

Journal of the Neurological Sciences

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To study the risk of acquiring Corona Virus Disease 2019 (COVID-19) and its outcomes in patients on immunosuppressive therapy (IST) for chronic autoimmune neuromuscular disorders (aNMD) and multiple sclerosis (MS). Methods: We used TriNetX, a global health collaborative clinical research platform collecting real-time electronic medical records data, which has one of the largest known global COVID-19 database. We included patients with chronic autoimmune neuromuscular disorders (aNMD) [myasthenia gravis (MG), inflammatory myositis, and chronic inflammatory neuropathies (CIN)] and MS, based on the International Classification of Disease-10 (ICD-10) coding for one year before January 20th, 2020. We examined the use of IST, rate of COVID-19, hospitalization, intubation, and mortality among the patients with aNMD and MS. Results: A total of 33,451 patients with aNMD and 42,899 patients with MS were included. Among them, 111 (0.33%) patients with aNMD and 115 patients (0.27%) with MS had COVID-19. About one third of them required hospitalization. IST did not appear to have a significant impact on overall infection risk in either group; however, risk of hospitalization for immunosuppressed patients with aNMD was higher (Odds ratio 2.86, p-value 0.011). Conclusions: IST use does not appear to make patients with aNMD and MS more vulnerable to COVID-19. IST may be continued during the pandemic, as previously suggested by expert opinion guidelines. However, it is important to consider individualizing immunotherapy regimens in some cases. Additional physician reported registry-based data is needed to further confirm these findings.

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“…In the present study, During the study period the drug therapy of patients with covid-19 changed continuously. In March 2020, many covid-19 patients in Sweden received off-label treatment with chloroquine phosphate/hydroxychloroquine, 21 until this use was stopped by the European Medicines Agency on April 1. However, this use may not have affected outcome, since a randomised control trial (RCT) by Horby et al 22 found that patients treated with hydroxychloroquine had similar mortality as those receiving standard of care treatment.…”

Section: Discussionmentioning

confidence: 99%

Decline in mortality among hospitalised covid-19 patients in Sweden: a nationwide observational study

Strålin

Wahlström

Walther

et al. 2020

Preprint

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OBJECTIVE It is important to know if mortality among hospitalised covid-19 patients has changed as the pandemic has progressed. The aim of this study was to describe the dynamics of mortality among patients hospitalised for covid-19 in a nationwide study. DESIGN Nationwide observational cohort study of all patients hospitalised in Sweden 1 March to 30 June 2020 with SARS-CoV-2 RNA positivity 14 days before to 5 days after admission, and a discharge code for covid-19. SETTING All hospitals in Sweden. PARTICIPANTS 15 761 hospitalised patients with covid-19, with data compiled by the Swedish National Board of Health and Welfare. MAIN OUTCOME MEASURES Outcome was 60-day all-cause mortality. Patients were stratified according to month of hospital admission. Poisson regression was used to estimate the relative risk of death by month of admission, adjusting for pre-existing conditions, age, sex, care dependency, and severity of illness (Simplified Acute Physiology, version 3), for patients in intensive care units (ICU). RESULTS The overall 60-day mortality was 17.8% (95% confidence interval (CI), 17.2% to 18.4%), and it decreased from 24.7% (95% CI, 23.0% to 26.5%) in March to 13.3% (95% CI, 12.1% to 14.7%) in June. Adjusted relative risk (RR) of death was 0.56 (95% CI, 0.51 to 0.63) for June, using March as reference. Corresponding RR for patients not admitted to ICU and those admitted to ICU were 0.60 (95% CI, 0.53 to 0.67) and 0.61 (95% CI, 0.48 to 0.79), 3 respectively. The proportion of patients admitted to ICU decreased from 19.5% (95% CI, 17.9% to 21.0%) in the March cohort to 11.0% (95% CI, 9.9% to 12.2%) in the June cohort. CONCLUSIONS There was a gradual decline in mortality from March to June 2020 in Swedish hospitalised covid-19 patients, which was independent of pre-existing conditions, age, and sex. Future research is needed to explain the reasons for this decline. The changing covid-19 mortality should be taken into account when management and results of studies from the first pandemic wave are evaluated.

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Characteristics and outcomes of patients with COVID‐19 admitted to ICU in a tertiary hospital in Stockholm, Sweden

Cited by 55 publications

References 8 publications

The Prevalence of Acute Kidney Injury in Patients Hospitalized With COVID-19 Infection: A Systematic Review and Meta-analysis

The Prevalence of Acute Kidney Injury in Patients Hospitalized With COVID-19 Infection: A Systematic Review and Meta-analysis

Immunosuppression in chronic autoimmune neurological disorders during the COVID-19 pandemic

Decline in mortality among hospitalised covid-19 patients in Sweden: a nationwide observational study

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