tetano
Editor, Senior Moderator
ERJ Open Res
. 2022 Feb 14;8(1):00552-2021.
doi: 10.1183/23120541.00552-2021. eCollection 2022 Jan.
Clinical characteristics, risk factors and outcomes in patients with severe COVID-19 registered in the International Severe Acute Respiratory and Emerging Infection Consortium WHO clinical characterisation protocol: a prospective, multinational, multicentre, observational study
Luis Felipe Reyes[SUP] 1 2 [/SUP], Srinivas Murthy[SUP] 3 [/SUP], Esteban Garcia-Gallo[SUP] 1 [/SUP], Mike Irvine[SUP] 4 [/SUP], Laura Merson[SUP] 2 [/SUP], Ignacio Martin-Loeches[SUP] 5 [/SUP], Jordi Rello[SUP] 6 [/SUP], Fabio S Taccone[SUP] 7 [/SUP], Robert A Fowler[SUP] 8 [/SUP], Annemarie B Docherty[SUP] 2 [/SUP], Christiana Kartsonaki[SUP] 2 [/SUP], Irene Aragao[SUP] 9 [/SUP], Peter W Barrett[SUP] 10 [/SUP], Abigail Beane[SUP] 11 [/SUP], Aidan Burrell[SUP] 12 [/SUP], Matthew Pellan Cheng[SUP] 13 [/SUP], Michael D Christian[SUP] 14 [/SUP], Jose Pedro Cidade[SUP] 15 [/SUP], Barbara Wanjiru Citarella[SUP] 2 [/SUP], Christl A Donnelly[SUP] 2 [/SUP], Susana M Fernandes[SUP] 16 [/SUP], Craig French[SUP] 17 [/SUP], Rashan Haniffa[SUP] 11 [/SUP], Ewen M Harrison[SUP] 2 [/SUP], Antonia Ying Wai Ho[SUP] 2 [/SUP], Mark Joseph[SUP] 18 [/SUP], Irfan Khan[SUP] 19 [/SUP], Michelle E Kho[SUP] 13 [/SUP], Anders Benjamin Kildal[SUP] 20 [/SUP], Demetrios Kutsogiannis[SUP] 21 [/SUP], François Lamontagne[SUP] 22 [/SUP], Todd C Lee[SUP] 13 [/SUP], Gianluigi Li Bassi[SUP] 23 [/SUP], Jose Wagner Lopez Revilla[SUP] 24 [/SUP], Catherine Marquis[SUP] 22 [/SUP], Jonathan Millar[SUP] 25 [/SUP], Raul Neto[SUP] 26 [/SUP], Alistair Nichol[SUP] 27 [/SUP], Rachael Parke[SUP] 28 [/SUP], Rui Pereira[SUP] 29 [/SUP], Sergio Poli[SUP] 30 [/SUP], Pedro Povoa[SUP] 15 [/SUP], Kollengode Ramanathan[SUP] 31 [/SUP], Oleksa Rewa[SUP] 21 [/SUP], Jordi Riera[SUP] 6 [/SUP], Sally Shrapnel[SUP] 23 [/SUP], Maria Joao Silva[SUP] 9 [/SUP], Andrew Udy[SUP] 12 [/SUP], Timothy Uyeki[SUP] 32 [/SUP], Steve A Webb[SUP] 12 [/SUP], Evert-Jan Wils[SUP] 33 [/SUP], Amanda Rojek[SUP] 2 [/SUP], Piero L Olliaro[SUP] 2 [/SUP]
Affiliations
Abstract
Due to the large number of patients with severe coronavirus disease 2019 (COVID-19), many were treated outside the traditional walls of the intensive care unit (ICU), and in many cases, by personnel who were not trained in critical care. The clinical characteristics and the relative impact of caring for severe COVID-19 patients outside the ICU is unknown. This was a multinational, multicentre, prospective cohort study embedded in the International Severe Acute Respiratory and Emerging Infection Consortium World Health Organization COVID-19 platform. Severe COVID-19 patients were identified as those admitted to an ICU and/or those treated with one of the following treatments: invasive or noninvasive mechanical ventilation, high-flow nasal cannula, inotropes or vasopressors. A logistic generalised additive model was used to compare clinical outcomes among patients admitted or not to the ICU. A total of 40 440 patients from 43 countries and six continents were included in this analysis. Severe COVID-19 patients were frequently male (62.9%), older adults (median (interquartile range (IQR), 67 (55-78) years), and with at least one comorbidity (63.2%). The overall median (IQR) length of hospital stay was 10 (5-19) days and was longer in patients admitted to an ICU than in those who were cared for outside the ICU (12 (6-23) days versus 8 (4-15) days, p<0.0001). The 28-day fatality ratio was lower in ICU-admitted patients (30.7% (5797 out of 18 831) versus 39.0% (7532 out of 19 295), p<0.0001). Patients admitted to an ICU had a significantly lower probability of death than those who were not (adjusted OR 0.70, 95% CI 0.65-0.75; p<0.0001). Patients with severe COVID-19 admitted to an ICU had significantly lower 28-day fatality ratio than those cared for outside an ICU.
. 2022 Feb 14;8(1):00552-2021.
doi: 10.1183/23120541.00552-2021. eCollection 2022 Jan.
Clinical characteristics, risk factors and outcomes in patients with severe COVID-19 registered in the International Severe Acute Respiratory and Emerging Infection Consortium WHO clinical characterisation protocol: a prospective, multinational, multicentre, observational study
Luis Felipe Reyes[SUP] 1 2 [/SUP], Srinivas Murthy[SUP] 3 [/SUP], Esteban Garcia-Gallo[SUP] 1 [/SUP], Mike Irvine[SUP] 4 [/SUP], Laura Merson[SUP] 2 [/SUP], Ignacio Martin-Loeches[SUP] 5 [/SUP], Jordi Rello[SUP] 6 [/SUP], Fabio S Taccone[SUP] 7 [/SUP], Robert A Fowler[SUP] 8 [/SUP], Annemarie B Docherty[SUP] 2 [/SUP], Christiana Kartsonaki[SUP] 2 [/SUP], Irene Aragao[SUP] 9 [/SUP], Peter W Barrett[SUP] 10 [/SUP], Abigail Beane[SUP] 11 [/SUP], Aidan Burrell[SUP] 12 [/SUP], Matthew Pellan Cheng[SUP] 13 [/SUP], Michael D Christian[SUP] 14 [/SUP], Jose Pedro Cidade[SUP] 15 [/SUP], Barbara Wanjiru Citarella[SUP] 2 [/SUP], Christl A Donnelly[SUP] 2 [/SUP], Susana M Fernandes[SUP] 16 [/SUP], Craig French[SUP] 17 [/SUP], Rashan Haniffa[SUP] 11 [/SUP], Ewen M Harrison[SUP] 2 [/SUP], Antonia Ying Wai Ho[SUP] 2 [/SUP], Mark Joseph[SUP] 18 [/SUP], Irfan Khan[SUP] 19 [/SUP], Michelle E Kho[SUP] 13 [/SUP], Anders Benjamin Kildal[SUP] 20 [/SUP], Demetrios Kutsogiannis[SUP] 21 [/SUP], François Lamontagne[SUP] 22 [/SUP], Todd C Lee[SUP] 13 [/SUP], Gianluigi Li Bassi[SUP] 23 [/SUP], Jose Wagner Lopez Revilla[SUP] 24 [/SUP], Catherine Marquis[SUP] 22 [/SUP], Jonathan Millar[SUP] 25 [/SUP], Raul Neto[SUP] 26 [/SUP], Alistair Nichol[SUP] 27 [/SUP], Rachael Parke[SUP] 28 [/SUP], Rui Pereira[SUP] 29 [/SUP], Sergio Poli[SUP] 30 [/SUP], Pedro Povoa[SUP] 15 [/SUP], Kollengode Ramanathan[SUP] 31 [/SUP], Oleksa Rewa[SUP] 21 [/SUP], Jordi Riera[SUP] 6 [/SUP], Sally Shrapnel[SUP] 23 [/SUP], Maria Joao Silva[SUP] 9 [/SUP], Andrew Udy[SUP] 12 [/SUP], Timothy Uyeki[SUP] 32 [/SUP], Steve A Webb[SUP] 12 [/SUP], Evert-Jan Wils[SUP] 33 [/SUP], Amanda Rojek[SUP] 2 [/SUP], Piero L Olliaro[SUP] 2 [/SUP]
Affiliations
- PMID: 35169585
- PMCID: PMC8669808
- DOI: 10.1183/23120541.00552-2021
Abstract
Due to the large number of patients with severe coronavirus disease 2019 (COVID-19), many were treated outside the traditional walls of the intensive care unit (ICU), and in many cases, by personnel who were not trained in critical care. The clinical characteristics and the relative impact of caring for severe COVID-19 patients outside the ICU is unknown. This was a multinational, multicentre, prospective cohort study embedded in the International Severe Acute Respiratory and Emerging Infection Consortium World Health Organization COVID-19 platform. Severe COVID-19 patients were identified as those admitted to an ICU and/or those treated with one of the following treatments: invasive or noninvasive mechanical ventilation, high-flow nasal cannula, inotropes or vasopressors. A logistic generalised additive model was used to compare clinical outcomes among patients admitted or not to the ICU. A total of 40 440 patients from 43 countries and six continents were included in this analysis. Severe COVID-19 patients were frequently male (62.9%), older adults (median (interquartile range (IQR), 67 (55-78) years), and with at least one comorbidity (63.2%). The overall median (IQR) length of hospital stay was 10 (5-19) days and was longer in patients admitted to an ICU than in those who were cared for outside the ICU (12 (6-23) days versus 8 (4-15) days, p<0.0001). The 28-day fatality ratio was lower in ICU-admitted patients (30.7% (5797 out of 18 831) versus 39.0% (7532 out of 19 295), p<0.0001). Patients admitted to an ICU had a significantly lower probability of death than those who were not (adjusted OR 0.70, 95% CI 0.65-0.75; p<0.0001). Patients with severe COVID-19 admitted to an ICU had significantly lower 28-day fatality ratio than those cared for outside an ICU.