Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study
Massimiliano Greco, Thomas De Corte, Ari Ercole, Massimo Antonelli, Élie Azoulay, Giuseppe Citerio, Andrew Conway Morris, Gennaro De Pascale, František Duška, Paul Elbers, Sharon Einav, Lui G. Forni, Laurą Galarza, Armand R. J. Girbes, Giacomo Grasselli, V. G. Gusarov, Alasdair Jubb, Jozef Kesecioğlu, Andrea Lavinio, M.C. Martín Delgado, Johannes Mellinghoff, Sheila Nainan Myatra, Marlies Ostermann, Mariangela Pellegrini, Pedro Póvoa, Stefan J. Schaller, Jean–Louis Teboul, Adrian Wong, Jan J. De Waele, Maurizio Cecconi, the ESICM UNITE-COVID investigators, Marco Bezzi, Alicia Gira, Philipp Eller, Tarikul Hamid, Injamam Ull Haque, Wim De Buyser, Antonella Cudia, Daniel De Backer, Pierre Foulon, Vincent Collin, Jan J. De Waele, Jolien Van Hecke, Elisabeth De Waele, Claire Van Malderen, Jean-Baptiste Mesland, Patrick Biston, Michaël Piagnerelli, Lionel Haentjens, Nicolas De Schryver, Jan Van Leemput, Philippe Vanhove, Pierre Bulpa, Viktoria Ilieva, David Katz, Alexandra Binnie, Anna Geagea, Fernando Tirapegui, Gustavo Lago, Jerónimo Graf, Rodrigo Perez-Araos, Patricio Vargas, Felipe Martínez, Eduardo Labarca, Daniel Franco, Daniela Parra-Tanoux, Luis Felipe Reyes, David Yepes, Filip Periš, Sanda Stojanović Stipić, Cynthia Vanessa Campozano Burgos, Paulo Roberto Navas Boada, Jose Luis Barberan Brun, Juan Pablo Paredes Ballesteros, G. Abdel-Nasser, Ahmed Hammouda, Omar Elmandouh, Ahmed Y. Azzam, Aliae Mohamed Hussein, Islam Galal, Ahmed K. Awad, Mohammed A. Azab, Maged Abdalla, Hebatallah Hany Assal, Mostafa Alfishawy, Sherief Ghozy, Samar Tharwat, Abdullah Eldaly, Anneli Ellervee, Veronika Reinhard, Anne Chrisment, Chrystelle Poyat, Julio Badié, Fernando Berdaguer Ferrari, Björn Weiß, Clara Schellenberg, Julius J. Grunow, Marco Lorenz, Stefan J. Schaller, Peter Spieth
Abstract
PURPOSE: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. METHODS: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. RESULTS: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%-50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. CONCLUSIONS: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality.