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- Title
Characteristics, Outcomes, and Trends of Patients With COVID-19-Related Critical Illness at a Learning Health System in the United States.
- Authors
Anesi, George L.; Jablonski, Juliane; Harhay, Michael O.; Atkins, Joshua H.; Bajaj, Jasmeet; Baston, Cameron; Brennan, Patrick J.; Candeloro, Christina L.; Catalano, Lauren M.; Cereda, Maurizio F.; Chandler, John M.; Christie, Jason D.; Collins, Tara; Courtright, Katherine R.; Fuchs, Barry D.; Gordon, Emily; Greenwood, John C.; Gudowski, Steven; Hanish, Asaf; Hanson III, C. William
- Abstract
<bold>Background: </bold>The coronavirus disease 2019 (COVID-19) pandemic continues to surge in the United States and globally.<bold>Objective: </bold>To describe the epidemiology of COVID-19-related critical illness, including trends in outcomes and care delivery.<bold>Design: </bold>Single-health system, multihospital retrospective cohort study.<bold>Setting: </bold>5 hospitals within the University of Pennsylvania Health System.<bold>Patients: </bold>Adults with COVID-19-related critical illness who were admitted to an intensive care unit (ICU) with acute respiratory failure or shock during the initial surge of the pandemic.<bold>Measurements: </bold>The primary exposure for outcomes and care delivery trend analyses was longitudinal time during the pandemic. The primary outcome was all-cause 28-day in-hospital mortality. Secondary outcomes were all-cause death at any time, receipt of mechanical ventilation (MV), and readmissions.<bold>Results: </bold>Among 468 patients with COVID-19-related critical illness, 319 (68.2%) were treated with MV and 121 (25.9%) with vasopressors. Outcomes were notable for an all-cause 28-day in-hospital mortality rate of 29.9%, a median ICU stay of 8 days (interquartile range [IQR], 3 to 17 days), a median hospital stay of 13 days (IQR, 7 to 25 days), and an all-cause 30-day readmission rate (among nonhospice survivors) of 10.8%. Mortality decreased over time, from 43.5% (95% CI, 31.3% to 53.8%) to 19.2% (CI, 11.6% to 26.7%) between the first and last 15-day periods in the core adjusted model, whereas patient acuity and other factors did not change.<bold>Limitations: </bold>Single-health system study; use of, or highly dynamic trends in, other clinical interventions were not evaluated, nor were complications.<bold>Conclusion: </bold>Among patients with COVID-19-related critical illness admitted to ICUs of a learning health system in the United States, mortality seemed to decrease over time despite stable patient characteristics. Further studies are necessary to confirm this result and to investigate causal mechanisms.<bold>Primary Funding Source: </bold>Agency for Healthcare Research and Quality.
- Subjects
UNITED States; CRITICALLY ill; COVID-19; DEATH forecasting; UNIVERSITY of Pennsylvania; UNITED States. Agency for Healthcare Research &; Quality; INTENSIVE care units; ADULT respiratory distress syndrome; ADULTS; MORTALITY
- Publication
Annals of Internal Medicine, 2021, Vol 174, Issue 5, p613
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/M20-5327