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Intensive care unit burden is associated with increased mortality in critically ill COVID-19 patients

Didriksson, Ingrid LU orcid ; Leffler, Märta LU orcid ; Spångfors, Martin LU orcid ; Lindberg, Sarah ; Reepalu, Anton LU orcid ; Nilsson, Anna LU ; Cronqvist, Jonas LU ; Andertun, Sara LU ; Nelderup, Maria and Jungner, Mårten LU , et al. (2023) In Acta Anaesthesiologica Scandinavica 67(3). p.329-338
Abstract

BACKGROUND: Traditional models to predict intensive care outcomes do not perform well in COVID-19. We undertook a comprehensive study of factors affecting mortality and functional outcome after severe COVID-19.

METHODS: In this prospective multicentre cohort study, we enrolled laboratory-confirmed, critically ill COVID-19 patients at six ICUs in the Skåne Region, Sweden, between May 11, 2020, and May 10, 2021. Demographics and clinical data were collected. ICU burden was defined as the total number of ICU-treated COVID-19 patients in the region on admission. Surviving patients had a follow-up at 90 days for assessment of functional outcome using the Glasgow Outcome Scale-Extended (GOSE), an ordinal scale (1-8) with GOSE ≥5... (More)

BACKGROUND: Traditional models to predict intensive care outcomes do not perform well in COVID-19. We undertook a comprehensive study of factors affecting mortality and functional outcome after severe COVID-19.

METHODS: In this prospective multicentre cohort study, we enrolled laboratory-confirmed, critically ill COVID-19 patients at six ICUs in the Skåne Region, Sweden, between May 11, 2020, and May 10, 2021. Demographics and clinical data were collected. ICU burden was defined as the total number of ICU-treated COVID-19 patients in the region on admission. Surviving patients had a follow-up at 90 days for assessment of functional outcome using the Glasgow Outcome Scale-Extended (GOSE), an ordinal scale (1-8) with GOSE ≥5 representing a favourable outcome. The primary outcome was 90-day mortality; the secondary outcome was functional outcome at 90 days.

RESULTS: Among 498 included patients, 74% were male with a median age of 66 years and a median body mass index (BMI) of 30 kg/m
2 . Invasive mechanical ventilation was employed in 72%. Mortality in the ICU, in-hospital and at 90 days was 30%, 38% and 39%, respectively. Mortality increased markedly at age 60 and older. Increasing ICU burden was independently associated with a two-fold increase in mortality. Higher BMI was not associated with increased mortality. Besides age and ICU burden, smoking status, cortisone use, P
a CO
2 >7 kPa, and inflammatory markers on admission were independent factors of 90-day mortality. Lower GOSE at 90 days was associated with a longer stay in the ICU.

CONCLUSION: In critically ill COVID-19 patients, the 90-day mortality was 39% and increased considerably at age 60 or older. The ICU burden was associated with mortality, whereas a high BMI was not. A longer stay in the ICU was associated with unfavourable functional outcomes at 90 days.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
90-day mortality, age, COVID-19, functional outcome, ICU burden
in
Acta Anaesthesiologica Scandinavica
volume
67
issue
3
pages
10 pages
publisher
Wiley-Blackwell
external identifiers
  • pmid:36537243
  • scopus:85145275966
ISSN
0001-5172
DOI
10.1111/aas.14184
project
SweCrit, a critical care biobank
language
English
LU publication?
yes
additional info
© 2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
id
43a25c2a-a9bd-406c-bdfb-93ade2c485af
date added to LUP
2023-01-02 20:19:46
date last changed
2024-09-21 00:05:42
@article{43a25c2a-a9bd-406c-bdfb-93ade2c485af,
  abstract     = {{<p>BACKGROUND: Traditional models to predict intensive care outcomes do not perform well in COVID-19. We undertook a comprehensive study of factors affecting mortality and functional outcome after severe COVID-19.</p><p>METHODS: In this prospective multicentre cohort study, we enrolled laboratory-confirmed, critically ill COVID-19 patients at six ICUs in the Skåne Region, Sweden, between May 11, 2020, and May 10, 2021. Demographics and clinical data were collected. ICU burden was defined as the total number of ICU-treated COVID-19 patients in the region on admission. Surviving patients had a follow-up at 90 days for assessment of functional outcome using the Glasgow Outcome Scale-Extended (GOSE), an ordinal scale (1-8) with GOSE ≥5 representing a favourable outcome. The primary outcome was 90-day mortality; the secondary outcome was functional outcome at 90 days.</p><p>RESULTS: Among 498 included patients, 74% were male with a median age of 66 years and a median body mass index (BMI) of 30 kg/m<br>
 2 . Invasive mechanical ventilation was employed in 72%. Mortality in the ICU, in-hospital and at 90 days was 30%, 38% and 39%, respectively. Mortality increased markedly at age 60 and older. Increasing ICU burden was independently associated with a two-fold increase in mortality. Higher BMI was not associated with increased mortality. Besides age and ICU burden, smoking status, cortisone use, P <br>
 a CO<br>
 2 &gt;7 kPa, and inflammatory markers on admission were independent factors of 90-day mortality. Lower GOSE at 90 days was associated with a longer stay in the ICU.<br>
 </p><p>CONCLUSION: In critically ill COVID-19 patients, the 90-day mortality was 39% and increased considerably at age 60 or older. The ICU burden was associated with mortality, whereas a high BMI was not. A longer stay in the ICU was associated with unfavourable functional outcomes at 90 days.</p>}},
  author       = {{Didriksson, Ingrid and Leffler, Märta and Spångfors, Martin and Lindberg, Sarah and Reepalu, Anton and Nilsson, Anna and Cronqvist, Jonas and Andertun, Sara and Nelderup, Maria and Jungner, Mårten and Johnsson, Patrik and Lilja, Gisela and Frigyesi, Attila and Friberg, Hans}},
  issn         = {{0001-5172}},
  keywords     = {{90-day mortality; age; COVID-19; functional outcome; ICU burden}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{329--338}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Anaesthesiologica Scandinavica}},
  title        = {{Intensive care unit burden is associated with increased mortality in critically ill COVID-19 patients}},
  url          = {{http://dx.doi.org/10.1111/aas.14184}},
  doi          = {{10.1111/aas.14184}},
  volume       = {{67}},
  year         = {{2023}},
}