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Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US

2020; American Medical Association; Volume: 180; Issue: 11 Linguagem: Inglês

10.1001/jamainternmed.2020.3596

2168-6114

Shruti Gupta, Salim S. Hayek, Wei Wang, Lili Chan, Kusum S. Mathews, Michal L. Melamed, Samantha K. Brenner, Amanda K. Leonberg‐Yoo, Edward J. Schenck, Jared Radbel, Jochen Reiser, Anip Bansal, Anand Srivastava, Yan Zhou, Anne Sutherland, Adam Green, Alexandre M. Shehata, Nitender Goyal, Anitha Vijayan, Juan Carlos Q. Velez, Shahzad Shaefi, Chirag R. Parikh, Justin Arunthamakun, Ambarish M. Athavale, Allon N. Friedman, Samuel Short, Zoé A. Kibbelaar, Samah Abu Omar, Andrew J. Admon, John P. Donnelly, Hayley B. Gershengorn, Miguel A. Hernán, Matthew W. Semler, David E. Leaf, Carl P. Walther, Samaya J. Anumudu, Kathleen F. Kopecky, Gregory P. Milligan, Peter A. McCullough, Thuy-Duyen Nguyen, Megan L. Krajewski, Sidharth Shankar, Ameeka Pannu, Juan D. Valencia, Sushrut S. Waikar, Peter C. Hart, Oyintayo Ajiboye, Matthew Itteera, Jean-Sébastien Rachoin, Christa Schorr, Lisa Shea, Daniel Edmonston, Christopher L. Mosher, Aaron Karp, Zaza Cohen, Valerie Allusson, Gabriela Bambrick‐Santoyo, Noor ul aain Bhatti, Bijal Mehta, Aquino Williams, Patricia Walters, Rolando C Go, Keith M. Rose, Amy M. Zhou, Ethan C. Kim, Rebecca Lisk, Steven G. Coca, Deena R. Altman, Aparna Saha, Howard Soh, Huei Hsun Wen, Sonali Bose, Emily Leven, Jing G. Wang, Gohar Mosoyan, Girish N. Nadkarni, John Guirguis, Rajat Kapoor, Christopher Meshberger, Brian T. Garibaldi, Celia P. Corona-Villalobos, Yumeng Wen, Steven Menez, Rubab F. Malik, Carmen Elena Cervantes, Samir C. Gautam, Hang Nguyen, Afshin Ahoubim, Leslie F. Thomas, Dheeraj Reddy Sirganagari, Pramod Guru, Paul A. Bergl, Jesús Rodríguez, Jatan A. Shah, Mrigank S. Gupta, Princy Kumar, Deepa G. Lazarous, Seble Kassaye, Tanya S. Johns, Ryan Mocerino, Kalyan Prudhvi, Denzel Zhu, Rebecca V. Levy, Yorg Azzi, Molly Fisher, Milagros Yunes, Kaltrina Sedaliu, Ladan Golestaneh, Maureen Brogan, Ritesh Raichoudhury, Soo Jung Cho, Maria Plataki, Sergio Alvarez-Mulett, Luis G. Gómez-Escobar, Di Pan, Stefi Lee, Jamuna Kirshnan, William Whalen, David M. Charytan, Ashley Macina, Daniel W. Ross, Alexander S. Leidner, Carlos Ruiz Martínez, Jacqueline M. Kruser, Richard G. Wunderink, Alexander J. Hodakowski, Eboni G. Price‐Haywood, Luis A. Matute-Trochez, Anne E Hasty, Muner Mohamed, Rupali S. Avasare, David Zonies, Rebecca M. Baron, Meghan E. Sise, Erik T. Newman, Kapil K. Pokharel, Shreyak Sharma, Harkarandeep Singh, Simon Correa, Tanveer Shaukat, Omer Kamal, Heather Yang, Benjamin G. Wu, Meghan Lee, Ian A. Strohbehn, Jiahua Li, Saif A. Muhsin, Ernest I. Mandel, Ariel Mueller, Nicholas S. Cairl, Chris Rowan, Farah Madhai-Lovely, Vasil Peev, John J. Byun, Andrew Vissing, Esha M. Kapania, Zoë Post, Nilam Patel, Joy-Marie Hermes, Amee Patrawalla, Diana G. Finkel, Barbara A. Danek, Sowminya Arikapudi, Jeffery M Paer, Isha Puri, Jag Sunderram, Matthew T. Scharf, Ayesha Ahmed, Ilya Berim, Sabiha Hussain, Shuchi Anand, Joseph E. Levitt, Pablo García, Suzanne M. Boyle, Rui Song, Jingjing Zhang, Moh’d A. Sharshir, Vadym V. Rusnak, Amber S. Podoll, Michel Chonchol, Sunita Sharma, Ellen L. Burnham, Arash Rashidi, Rana Hejal, Erik T Judd, Laura Latta, Ashita J. Tolwani, Timothy E. Albertson, Jason Y. Adams, Steven Y. Chang, Rebecca M. Beutler, Carl E. Schulze, Etienne Macedo, Harin Rhee, Kathleen D. Liu, Vasantha Jotwani, Jay L. Koyner, Chintan V. Shah, Vishal Jaikaransingh, Stephanie M. Toth‐Manikowski, Min J. Joo, James P. Lash, Javier A. Neyra, Nourhan Chaaban, Alfredo Iardino, Elizabeth H. Au, Jill H. Sharma, Marie Anne Sosa, Sabrina Taldone, Gabriel Contreras, David De La Zerda, Pennelope Blakely, Hanna Berlin, Tariq U. Azam, Husam Shadid, Michael Pan, Patrick O’Hayer, Chelsea Meloche, Rafey Feroze, Kishan Padalia, Abbas Bitar, Jennifer E. Flythe, Matthew J. Tugman, Brent R. Brown, Ryan Spiardi, Todd A. Miano, Meaghan S. Roche, Charles R. Vasquez, Amar D. Bansal, Natalie C. Ernecoff, Csaba P. Kövesdy, Miklos Z. Molnar, Ambreen Azhar, S. Susan Hedayati, Mridula Nadamuni, Sadaf Khan, DuWayne L. Willett, Amanda D. Renaghan, Pavan K. Bhatraju, Bilal Malik, Christina Mariyam Joy, Tingting Li, Seth Goldberg, Patricia F. Kao, Greg Schumaker, Anthony J. Faugno, Caroline M. Hsu, Asma Tariq, Leah Meyer, Daniel E. Weiner, Marta Christov, F. Perry Wilson, Tanima Arora, Ugochukwu Ugwuowo,

Sepsis Diagnosis and Treatment

Importance The US is currently an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet few national data are available on patient characteristics, treatment, and outcomes of critical illness from COVID-19. Objectives To assess factors associated with death and to examine interhospital variation in treatment and outcomes for patients with COVID-19. Design, Setting, and Participants This multicenter cohort study assessed 2215 adults with laboratory-confirmed COVID-19 who were admitted to intensive care units (ICUs) at 65 hospitals across the US from March 4 to April 4, 2020. Exposures Patient-level data, including demographics, comorbidities, and organ dysfunction, and hospital characteristics, including number of ICU beds. Main Outcomes and Measures The primary outcome was 28-day in-hospital mortality. Multilevel logistic regression was used to evaluate factors associated with death and to examine interhospital variation in treatment and outcomes. Results A total of 2215 patients (mean [SD] age, 60.5 [14.5] years; 1436 [64.8%] male; 1738 [78.5%] with at least 1 chronic comorbidity) were included in the study. At 28 days after ICU admission, 784 patients (35.4%) had died, 824 (37.2%) were discharged, and 607 (27.4%) remained hospitalized. At the end of study follow-up (median, 16 days; interquartile range, 8-28 days), 875 patients (39.5%) had died, 1203 (54.3%) were discharged, and 137 (6.2%) remained hospitalized. Factors independently associated with death included older age (≥80 vs <40 years of age: odds ratio [OR], 11.15; 95% CI, 6.19-20.06), male sex (OR, 1.50; 95% CI, 1.19-1.90), higher body mass index (≥40 vs <25: OR, 1.51; 95% CI, 1.01-2.25), coronary artery disease (OR, 1.47; 95% CI, 1.07-2.02), active cancer (OR, 2.15; 95% CI, 1.35-3.43), and the presence of hypoxemia (Pao 2 :Fio 2 <100 vs ≥300 mm Hg: OR, 2.94; 95% CI, 2.11-4.08), liver dysfunction (liver Sequential Organ Failure Assessment score of 2-4 vs 0: OR, 2.61; 95% CI, 1.30–5.25), and kidney dysfunction (renal Sequential Organ Failure Assessment score of 4 vs 0: OR, 2.43; 95% CI, 1.46–4.05) at ICU admission. Patients admitted to hospitals with fewer ICU beds had a higher risk of death (<50 vs ≥100 ICU beds: OR, 3.28; 95% CI, 2.16-4.99). Hospitals varied considerably in the risk-adjusted proportion of patients who died (range, 6.6%-80.8%) and in the percentage of patients who received hydroxychloroquine, tocilizumab, and other treatments and supportive therapies. Conclusions and Relevance This study identified demographic, clinical, and hospital-level risk factors that may be associated with death in critically ill patients with COVID-19 and can facilitate the identification of medications and supportive therapies to improve outcomes.