tetano
Editor, Senior Moderator
J Intensive Care Soc
. 2021 Nov;22(4):270-279.
doi: 10.1177/1751143720961672. Epub 2020 Oct 8.
Critical care outcomes, for the first 200 patients with confirmed COVID-19, in England, Wales and Northern Ireland: A report from the ICNARC Case Mix Programme
Alvin Richards-Belle[SUP] 1 [/SUP], Izabella Orzechowska[SUP] 1 [/SUP], James Doidge[SUP] 1 [/SUP], Karen Thomas[SUP] 1 [/SUP], David A Harrison[SUP] 1 [/SUP], Abby Koelewyn[SUP] 1 [/SUP], Michael D Christian[SUP] 2 [/SUP], Manu Shankar-Hari[SUP] 3 [/SUP], Kathryn M Rowan[SUP] 1 [/SUP], Doug W Gould[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Early in a pandemic, outcomes are biased towards patients with shorter durations of critical illness. We describe 60-day outcomes for patients critically ill with confirmed COVID-19 and explore the potential bias in the weekly reported data by ICNARC.
Methods: First 200 consecutive patients with confirmed COVID-19, admitted for critical care in England, Wales and Northern Ireland, followed-up for a minimum of 60 days from admission. Outcomes included survival and duration of critical care, receipt/duration of organ support in critical care and hospital survival.
Results: Mean age was 62.6 years, 70.5% were male, 52.0% were white, 39.2% obese and 9.0% had serious comorbidities. Median APACHE II score was 16 (IQR 12, 19). After 60 days, 83 (41.5%) patients had been discharged from hospital, 15 (7.5%) had been discharged from critical care but remained in hospital, 1 (0.5%) was still receiving critical care, 90 (45.0%) had died while receiving critical care and 11 (5.5%) had died in hospital after discharge from critical care. Median duration of critical care was 14.0 days (IQR 6.1, 23.0) for survivors and 10.0 days (IQR 5.0, 16.0) for non-survivors of critical care. Overall, 158 (79.0%) patients received advanced respiratory support for a median of 13 (IQR 8, 20) calendar days. Compared with weekly reports during the pandemic, critical care mortality started higher than but then decreased below that of the first 200 consecutive patients. Duration of critical care, for both survivors and non-survivors increased over time; however, both were still lower than those for the first 200 consecutive patients. Receipt and duration of organ support increased to values similar to those for the first 200 consecutive patients.
Conclusion: COVID-19 in critical care has high mortality and places a large burden on resources. Analysis of preliminary data with limited follow-up should be interpreted with caution, particularly for future planning in a pandemic.
Keywords: COVID-19; coronavirus; intensive care; outcomes.
. 2021 Nov;22(4):270-279.
doi: 10.1177/1751143720961672. Epub 2020 Oct 8.
Critical care outcomes, for the first 200 patients with confirmed COVID-19, in England, Wales and Northern Ireland: A report from the ICNARC Case Mix Programme
Alvin Richards-Belle[SUP] 1 [/SUP], Izabella Orzechowska[SUP] 1 [/SUP], James Doidge[SUP] 1 [/SUP], Karen Thomas[SUP] 1 [/SUP], David A Harrison[SUP] 1 [/SUP], Abby Koelewyn[SUP] 1 [/SUP], Michael D Christian[SUP] 2 [/SUP], Manu Shankar-Hari[SUP] 3 [/SUP], Kathryn M Rowan[SUP] 1 [/SUP], Doug W Gould[SUP] 1 [/SUP]
Affiliations
- PMID: 35145562
- PMCID: PMC7548541
- DOI: 10.1177/1751143720961672
Abstract
Background: Early in a pandemic, outcomes are biased towards patients with shorter durations of critical illness. We describe 60-day outcomes for patients critically ill with confirmed COVID-19 and explore the potential bias in the weekly reported data by ICNARC.
Methods: First 200 consecutive patients with confirmed COVID-19, admitted for critical care in England, Wales and Northern Ireland, followed-up for a minimum of 60 days from admission. Outcomes included survival and duration of critical care, receipt/duration of organ support in critical care and hospital survival.
Results: Mean age was 62.6 years, 70.5% were male, 52.0% were white, 39.2% obese and 9.0% had serious comorbidities. Median APACHE II score was 16 (IQR 12, 19). After 60 days, 83 (41.5%) patients had been discharged from hospital, 15 (7.5%) had been discharged from critical care but remained in hospital, 1 (0.5%) was still receiving critical care, 90 (45.0%) had died while receiving critical care and 11 (5.5%) had died in hospital after discharge from critical care. Median duration of critical care was 14.0 days (IQR 6.1, 23.0) for survivors and 10.0 days (IQR 5.0, 16.0) for non-survivors of critical care. Overall, 158 (79.0%) patients received advanced respiratory support for a median of 13 (IQR 8, 20) calendar days. Compared with weekly reports during the pandemic, critical care mortality started higher than but then decreased below that of the first 200 consecutive patients. Duration of critical care, for both survivors and non-survivors increased over time; however, both were still lower than those for the first 200 consecutive patients. Receipt and duration of organ support increased to values similar to those for the first 200 consecutive patients.
Conclusion: COVID-19 in critical care has high mortality and places a large burden on resources. Analysis of preliminary data with limited follow-up should be interpreted with caution, particularly for future planning in a pandemic.
Keywords: COVID-19; coronavirus; intensive care; outcomes.