Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis

Chandel, Abhimanyu; Leazer, Sahar; Alcover, Karl C.; Farley, Josiah; Berk, Joshua; Jayne, Christopher; Mcnutt, Ryan; Olsen, Meredith; Allard, Rhonda J.; Yang, Jiahong; Johnson, Caitlyn; Tripathi, Ananya; Rechtin, Maria; Leon, Mathew; Williams, M.; Sheth, Phorum; Messer, Kyle; Chung, Kevin K.; Collen, Jacob

doi:10.1097/cce.0000000000000876

Cited by 6 publications

(7 citation statements)

References 186 publications

(194 reference statements)

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“…In the present cohort study, performed in adult critically ill patients with COVID-19 admitted to the ICU and followed up during the first 12 months after ICU discharge, we observed an ICU mortality of 20.1%, which is inferior to previous studies where the reported mortality ranged between 30 to 65% [ 12 – 14 ]. Moreover, regarding ICU survivors, early mortality, considering 30 days after ICU discharge, was 5.3% and late mortality (from day 31 to day 365) was 2.6%; thus, the overall 1-year mortality observed among ICU survivors was 7.9% and the overall 1-year mortality among all the COVID-19 patients admitted to the ICU was 26.5%.…”

Section: Discussioncontrasting

confidence: 94%

Predictors of early and long-term mortality after ICU discharge in critically ill COVID-19 patients: A prospective cohort study

Santos,

Pereira,

Cuboia

et al. 2023

PLoS ONE

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Background To mitigate mortality among critically ill COVID-19 patients, both during their Intensive Care Unit (ICU) stay and following ICU discharge, it is crucial to measure its frequency, identify predictors and to establish an appropriate post-ICU follow-up strategy. Methods In this multicentre, prospective cohort study, we included 586 critically ill COVID-19 patients. Results We observed an overall ICU mortality of 20.1% [95%CI: 17.1% to 23.6%] (118/586) and an overall hospital mortality of 25.4% [95%CI: 22.1% to 29.1%] (149/586). For ICU survivors, 30 days (early) post-ICU mortality was 5.3% [95%CI: 3.6% to 7.8%] (25/468) and one-year (late) post-ICU mortality was 7.9% [95%CI: 5.8% to 10.8%] (37/468). Pre-existing conditions/comorbidities were identified as the main independent predictors of mortality after ICU discharge: hypertension and heart failure were independent predictors of early mortality; and hypertension, chronic kidney disease, chronic obstructive pulmonary disease and cancer were independent predictors of late mortality. Conclusion Early and late post-ICU mortality exhibited an initial surge (in the first 30 days post-ICU) followed by a subsequent decline over time. Close monitoring of critically ill COVID-19 post-ICU survivors, especially those with pre-existing conditions, is crucial to prevent adverse outcomes, reduce mortality and to establish an appropriate follow-up strategy.

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Section: Discussioncontrasting

confidence: 94%

Predictors of early and long-term mortality after ICU discharge in critically ill COVID-19 patients: A prospective cohort study

Santos,

Pereira,

Cuboia

et al. 2023

PLoS ONE

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“…3 A finding also supported by a newly published systematic review. 26 Importantly, although COVID-19 therapy and, possibly, virus subgroup virulence changed throughout the pandemic, in the post hoc interaction analysis we found no effect modification of date of inclusion on the primary outcome.…”

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confidence: 61%

“…Consistently, the overall mortality at 90 days was more than 10 percentage points lower in patients enrolled in the present trial compared with those included in the first-wave COVID-19 subgroup analysis of the HOT-ICU trial . A finding also supported by a newly published systematic review . Importantly, although COVID-19 therapy and, possibly, virus subgroup virulence changed throughout the pandemic, in the post hoc interaction analysis we found no effect modification of date of inclusion on the primary outcome.…”

Section: Discussionmentioning

confidence: 99%

Lower vs Higher Oxygenation Target and Days Alive Without Life Support in COVID-19

Nielsen,

Klitgaard,

Siegemund

et al. 2024

JAMA

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ImportanceSupplemental oxygen is ubiquitously used in patients with COVID-19 and severe hypoxemia, but a lower dose may be beneficial.ObjectiveTo assess the effects of targeting a Pao2 of 60 mm Hg vs 90 mm Hg in patients with COVID-19 and severe hypoxemia in the intensive care unit (ICU).Design, Setting, and ParticipantsMulticenter randomized clinical trial including 726 adults with COVID-19 receiving at least 10 L/min of oxygen or mechanical ventilation in 11 ICUs in Europe from August 2020 to March 2023. The trial was prematurely stopped prior to outcome assessment due to slow enrollment. End of 90-day follow-up was June 1, 2023.InterventionsPatients were randomized 1:1 to a Pao2 of 60 mm Hg (lower oxygenation group; n = 365) or 90 mm Hg (higher oxygenation group; n = 361) for up to 90 days in the ICU.Main Outcomes and MeasuresThe primary outcome was the number of days alive without life support (mechanical ventilation, circulatory support, or kidney replacement therapy) at 90 days. Secondary outcomes included mortality, proportion of patients with serious adverse events, and number of days alive and out of hospital, all at 90 days.ResultsOf 726 randomized patients, primary outcome data were available for 697 (351 in the lower oxygenation group and 346 in the higher oxygenation group). Median age was 66 years, and 495 patients (68%) were male. At 90 days, the median number of days alive without life support was 80.0 days (IQR, 9.0-89.0 days) in the lower oxygenation group and 72.0 days (IQR, 2.0-88.0 days) in the higher oxygenation group (P = .009 by van Elteren test; supplemental bootstrapped adjusted mean difference, 5.8 days [95% CI, 0.2-11.5 days]; P = .04). Mortality at 90 days was 30.2% in the lower oxygenation group and 34.7% in the higher oxygenation group (risk ratio, 0.86 [98.6% CI, 0.66-1.13]; P = .18). There were no statistically significant differences in proportion of patients with serious adverse events or in number of days alive and out of hospital.Conclusion and RelevanceIn adult ICU patients with COVID-19 and severe hypoxemia, targeting a Pao2 of 60 mm Hg resulted in more days alive without life support in 90 days than targeting a Pao2 of 90 mm Hg.Trial RegistrationClinicalTrials.gov Identifier: NCT04425031

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“…Additionally, widespread vaccination campaigns have helped protect vulnerable populations and reduce the overall number of severe cases requiring ICU admission. This global improvement in managing ICU-admitted COVID-19 patients permitted a reduction in deaths [ 62 ]. In the last meta-analysis, including about 1 million patients with COVID-19 admitted to ICUs, the case fatality rate (CFR) due to COVID-19 was 37.3% (95% CI: 34.6–40.1) [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

Mortality in ICU Patients with COVID-19-Associated Pulmonary Aspergillosis

Beltrame

Stevens

Haiduven

2023

JoF

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A review of 38 studies involving 1437 COVID-19 patients admitted to intensive care units (ICUs) with pulmonary aspergillosis (CAPA) was conducted to investigate whether mortality has improved since the pandemic’s onset. The study found that the median ICU mortality was 56.8%, ranging from 30% to 91.8%. These rates were higher for patients admitted during 2020–2021 (61.4%) compared to 2020 (52.3%), and prospective studies found higher ICU mortality (64.7%) than retrospective ones (56.4%). The studies were conducted in various countries and used different criteria to define CAPA. The percentage of patients who received antifungal therapy varied across studies. These results indicate that the mortality rate among CAPA patients is a growing concern, mainly since there has been an overall reduction in mortality among COVID-19 patients. Urgent action is needed to improve prevention and management strategies for CAPA, and additional research is needed to identify optimal treatment strategies to reduce mortality rates among these patients. This study serves as a call to action for healthcare professionals and policymakers to prioritize CAPA, a serious and potentially life-threatening complication of COVID-19.

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Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis

Cited by 6 publications

References 186 publications

Predictors of early and long-term mortality after ICU discharge in critically ill COVID-19 patients: A prospective cohort study

Predictors of early and long-term mortality after ICU discharge in critically ill COVID-19 patients: A prospective cohort study

Lower vs Higher Oxygenation Target and Days Alive Without Life Support in COVID-19

Mortality in ICU Patients with COVID-19-Associated Pulmonary Aspergillosis

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