National outcomes and characteristics of patients admitted to Swedish intensive care units for COVID-19

Abstract

BACKGROUND Mortality among patients admitted to intensive care units (ICUs) with COVID-19 is unclear due to variable follow-up periods. Few nationwide data are available to compare risk factors, treatment and outcomes of COVID-19 patients after ICU admission. OBJECTIVE To evaluate baseline characteristics, treatments and 30-day outcomes of patients admitted to Swedish ICUs with COVID-19. DESIGN Registry-based cohort study with prospective data collection. SETTING Admissions to Swedish ICUs from 6 March to 6 May 2020 with laboratory confirmed COVID-19 disease. PARTICIPANTS Adult patients admitted to Swedish ICUs. EXPOSURES Baseline characteristics, intensive care treatments and organ failures. MAIN OUTCOMES AND MEASURES The primary outcome was 30-day all-cause mortality. A multivariable model was used to determine the independent association between potential predictor variables and death. RESULTS We identified 1563 patients with complete 30-day follow-up. The 30-day all-cause mortality was 26.7%. Median age was 61 [52 to 69], Simplified Acute Physiology Score III (SAPS III) was 53 [46 to 59] and 62.5% had at least one comorbidity. Median PaO2/FiO2 on admission was 97.5 [75.0 to 140.6] mmHg, 74.7% suffered from moderate-to-severe acute respiratory failure. Age, male sex [adjusted odds ratio (aOR) 1.5 (1.1 to 2.2)], SAPS III score [aOR 1.3 (1.2 to 1.4)], severe respiratory failure [aOR 3.0 (2.0 to 4.7)], specific COVID-19 pharmacotherapy [aOR 1.4 (1.0 to 1.9)] and continuous renal replacement therapy [aOR 2.1 (1.5 to 3.0)] were associated with increased mortality. Except for chronic lung disease, the presence of comorbidities was not independently associated with mortality. CONCLUSIONS Thirty-day mortality rate in COVID-19 patients admitted to Swedish ICUs is generally lower than previously reported despite a severe degree of hypoxaemia on admission. Mortality was driven by age, baseline disease severity, the presence and degree of organ failure, rather than pre-existing comorbidities. TRIAL REGISTRATION NO NCT04462393

Low mortality rates among critically ill adults with COVID‐19 at three non‐academic intensive care units in south Sweden

“…With the exception of the results of a smaller, single‐centre cohort study conducted in Norway, 8 the LOS in the ICU compared well within Scandinavia. 3 , 4 , 5 , 6 , 7 By contrast, in the present study, the median LOS was slightly shorter, with a median of 10 days (IQR, 3–19). First, a feasible explanation could be our liberal approach to tracheostomies (60%) in combination with the possibility of discharging tracheotomised patients to intermediate care (non‐ICU) wards.…”

“…By contrast, the rate of use of prone positioning during IMV was substantially higher in this study. 3 , 4 , 5 , 6 , 7 , 8 , 19 In a Swedish report published by Chew et al, 40% of patients had severe ARDS, which is roughly twice that reported by Laake et al in Norway and the present study. ARDS severity correlates well with mortality and could explain some of the differences between the studies.…”

“…The main findings were the low 30‐day and in‐hospital mortality rates that compared well with the results from both Scandinavian tertiary centre ICUs and national data sets during W1. 3 , 4 , 5 , 6 , 7 , 8 Furthermore, the mortality rates were consistently low throughout both pandemic waves during the first year.…”

“… 1 , 2 In comparison, more recent reports from Scandinavia and central Europe have shown lower 30‐day mortality rates. 3 , 4 , 5 , 6 , 7 , 8 , 9 The first case of COVID‐19 in Sweden was reported in Jönköping on the 31st of January 2020 in a patient who had travelled abroad. Six weeks later, on 14 March 2020, the first patient with COVID‐19 was admitted to an intensive care department in Jönköping County.…”

Simulating the impact of non-pharmaceutical interventions limiting transmission in COVID-19 epidemics using a membrane computing model

“…A number of countries, such as Sweden, adopted a de-facto herd immunity approach, without imposing severe limitations to viral propagation in the community, with controversial results (Bjorklund and Ewing, 2020;Claeson and Hanson, 2020). The goal of the Swedish Public Health Agency was to assure the intensive care for elderly patients with the highest mortality risk (Chew et al, 2021). This approach could probably have been accompanied by a strict lockdown for the elderly.…”