A study published in JAMAInternal Medicine researched the characteristics, outcomes, and factors associated with death among critically ill patients with coronavirus disease 2019 (COVID-19) in the US.
The findings looked at intensive care units at 65 sites, where 784 (35.4%) patients died within 28 days, with wide variation among hospitals. Factors associated with death included older age, male sex, obesity, coronary artery disease, cancer, acute organ dysfunction, and admission to a hospital with fewer intensive care unit beds.
As of June 19, 2020, approximately 2.2 million people in the US have been infected with SARS-CoV-2, and more than 100 000 have died. Although more people have died in the US than in any other country, national data are lacking on the epidemiologic factors, treatment, and outcomes of critical illness from COVID-19. One study of 24 patients in the Seattle, Washington, region reported frequent receipt of invasive mechanical ventilatory support and vasopressors and an in-hospital mortality of 50%. Local outbreaks of COVID-19 in New York City have been described in single-center and regional reports. These studies included primarily noncritically ill patients and had limited follow-up duration.
Granular data on patient characteristics, treatment, and outcomes of critical illness from COVID-19 are needed to inform decision-making about resource allocation, critical care capacity, and treatment of patients. Furthermore, nationally representative data across multiple hospitals are needed to assess interhospital variation in treatment and outcomes. To address this knowledge gap, we conducted the Study of the Treatment and Outcomes in Critically Ill Patients With COVID-19 (STOP-COVID), a multicenter cohort study that examined the demographics, comorbidities, organ dysfunction, treatment, and outcomes of patients with COVID-19 admitted to ICUs across the US. The purposes of this study were to assess factors associated with death and to examine interhospital variation in treatment and outcomes in patients with COVID-19.
The primary outcome was death within 28 days of ICU admission. Patients who were discharged alive from the hospital before 28 days were considered to be alive at 28 days. Secondary outcomes included development of respiratory failure, acute respiratory distress syndrome, congestive heart failure, myocarditis, pericarditis, arrhythmia, shock, acute cardiac injury, acute kidney injury, acute liver injury, coagulopathy, secondary infection, and thromboembolic events. We also examined receipt of antivirals, antibiotics, anticoagulants, immunomodulating medications, mechanical ventilatory support, adjunctive and rescue therapies for hypoxemia, extracorporeal membrane oxygenation, mechanical cardiac support, vasopressors, and kidney replacement therapy.
In the 14 days after ICU admission, 1859 patients (83.9%) received invasive mechanical ventilatory support, 1635 patients (73.8%) developed acute respiratory distress syndrome, and 921 of the 2151 patients without end-stage kidney disease (42.8%) developed acute kidney injury. Other acute organ injuries were less frequent in this study, with only 230 patients (10.4%) experiencing a clinically detected thromboembolic event.
The most commonly administered medications for COVID-19–related illness were hydroxychloroquine (1761 [79.5%]), azithromycin (1320 [59.6%]), and therapeutic anticoagulants (920 [41.5%]). Interventions for hypoxemia included neuromuscular blockade (909 [41.0%]), prone positioning (852 [38.5%]), inhaled epoprostenol (118 [5.3%]), and inhaled nitric oxide (94 [4.2%]).
Among patients discharged alive from the hospital within 28 days of ICU admission, the median ICU length of stay was 9 days (IQR, 5-14 days) and the median hospital length of stay was 16 days (IQR, 11-22 days). Extracorporeal organ support included acute kidney replacement therapy (432 [20.1%]), extracorporeal membrane oxygenation (61 [2.8%]), and mechanical cardiac support (3 [0.1%]).
