Clinical characteristics, risk factors and outcomes in patients with severe COVID-19 registered in the International Severe Acute Respiratory and Emerging Infection Consortium WHO clinical characterisation protocol: a prospective, multinational, multicentre, observational study
Luis Felipe Reyes, Srinivas Murthy, Esteban García-Gallo, Mike Irvine, Laura Merson, Ignacio Martín‐Loeches, Jordi Rello, Fabio Silvio Taccone, Robert Fowler, Annemarie B Docherty, Christiana Kartsonaki, Irene Aragão, Peter Barrett, Abi Beane, Aidan Burrell, Matthew Pellan Cheng, Christian Sandrock, José Pedro Cidade, Barbara Wanjiru Citarella, Christl A. Donnelly, S. M. L. Fernandes, Craig French, Rashan Haniffa, Ewen M. Harrison, Antonia Ho, Mark Joseph, Irfan Khan, Michelle E. Kho, Anders Benjamin Kildal, Demetrios J. Kutsogiannis, François Lamontagne, Todd C. Lee, Gianluigi Li Bassi, José W. López, Catherine Marquis, Jonathan Millar, Raul Neto, Alistair Nichol, Rachael Parke, Rui Pereira, Sergio Poli, Pedro Póvoa, Kollengode Ramanathan, Oleksa Rewa, Jordi Riera, Sally Shrapnel, Maria Silva, Andrew Udy, Timothy M. Uyeki, Steve Webb, Evert‐Jan Wils, Amanda Rojek, Piero Olliaro
Abstract
Due to the large number of patients with severe coronavirus disease 2019 (COVID-19), many were treated outside the traditional walls of the intensive care unit (ICU), and in many cases, by personnel who were not trained in critical care. The clinical characteristics and the relative impact of caring for severe COVID-19 patients outside the ICU is unknown. This was a multinational, multicentre, prospective cohort study embedded in the International Severe Acute Respiratory and Emerging Infection Consortium World Health Organization COVID-19 platform. Severe COVID-19 patients were identified as those admitted to an ICU and/or those treated with one of the following treatments: invasive or noninvasive mechanical ventilation, high-flow nasal cannula, inotropes or vasopressors. A logistic generalised additive model was used to compare clinical outcomes among patients admitted or not to the ICU. A total of 40 440 patients from 43 countries and six continents were included in this analysis. Severe COVID-19 patients were frequently male (62.9%), older adults (median (interquartile range (IQR), 67 (55–78) years), and with at least one comorbidity (63.2%). The overall median (IQR) length of hospital stay was 10 (5–19) days and was longer in patients admitted to an ICU than in those who were cared for outside the ICU (12 (6–23) days versus 8 (4–15) days, p<0.0001). The 28-day fatality ratio was lower in ICU-admitted patients (30.7% (5797 out of 18 831) versus 39.0% (7532 out of 19 295), p<0.0001). Patients admitted to an ICU had a significantly lower probability of death than those who were not (adjusted OR 0.70, 95% CI 0.65–0.75; p<0.0001). Patients with severe COVID-19 admitted to an ICU had significantly lower 28-day fatality ratio than those cared for outside an ICU.