Association of Surge Conditions with Mortality Among Critically Ill Patients with COVID-19
Adam Keene, Andrew J. Admon, Samantha K. Brenner, Shruti Gupta, Deepa G. Lazarous, David E. Leaf, Hayley B. Gershengorn, Carl P. Walther, Samaya J. Anumudu, Justin Arunthamakun, Kathleen F. Kopecky, Gregory P. Milligan, Peter A. McCullough, Thuy-Duyen Nguyen, Shahzad Shaefi, Brian O’Gara, Megan L. Krajewski, Sean M Baskin, Sidharth Shankar, Juan D. Valencia, Ameeka Pannu, Margaret M. Hayes, E. Wilson Grandin, Sushrut S. Waikar, Zoé A. Kibbelaar, Ambarish M. Athavale, Peter C. Hart, Shristi Upadhyay, Ishaan Vohra, Oyintayo Ajiboye, Adam Green, Jean-Sébastien Rachoin, Christa Schorr, Lisa Shea, Daniel Edmonston, Christopher L. Mosher, Alexandre M. Shehata, Zaza Cohen, Valerie Allusson, Gabriela Bambrick‐Santoyo, Noor ul aain Bhatti, Bijal Mehta, Aquino Williams, Samantha K. Brenner, Patricia Walters, Ronaldo C. Go, Keith Rose, Miguel A. Hernán, Rebecca Lisk, Lili Chan, Kusum S. Mathews, 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, Pattharawin Pattharanitima, Emily J. Gallagher, Allon N. Friedman, John Guirguis, Rajat Kapoor, Christopher Meshberger, Katherine Kelly, Chirag R. Parikh, Brian T. Garibaldi, Celia P. Corona‐Villalobos, Yumeng Wen, Steven Menez, Rubab F. Malik, C. Elena Cervantes, Samir C. Gautam, Mary C. Mallappallil, Jie Ouyang, Sabu John, Ernie Yap, Yohannes Adama Melaku, Ibrahim Mohamed, Siddhartha Bajracharya, Isha Puri, Mariah Thaxton, Jyotsna Bhattacharya, John E. Wagner, Leon Boudourakis, H. Bryant Nguyen, Afshin Ahoubim, Leslie F. Thomas, Dheeraj Reddy Sirganagari, Pramod Guru, Kianoush Kashani, Shahrzad Tehranian, Yan Zhou, Paul A. Bergl, Jesús Rodríguez, Jatan A. Shah, Mrigank S. Gupta
Abstract
OBJECTIVE: To determine whether surge conditions were associated with increased mortality. DESIGN: Multicenter cohort study. SETTING: U.S. ICUs participating in STOP-COVID. PATIENTS: Consecutive adults with COVID-19 admitted to participating ICUs between March 4 and July 1, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome was 28-day in-hospital mortality. To assess the association between admission to an ICU during a surge period and mortality, we used two different strategies: (1) an inverse probability weighted difference-in-differences model limited to appropriately matched surge and non-surge patients and (2) a meta-regression of 50 multivariable difference-in-differences models (each based on sets of randomly matched surge- and non-surge hospitals). In the first analysis, we considered a single surge period for the cohort (March 23 - May 6). In the second, each surge hospital had its own surge period (which was compared to the same time periods in matched non-surge hospitals).Our cohort consisted of 4342 ICU patients (average age 60.8 [sd 14.8], 63.5% men) in 53 U.S. hospitals. Of these, 13 hospitals encountered surge conditions. In analysis 1, the increase in mortality seen during surge was not statistically significant (odds ratio [95% CI]: 1.30 [0.47-3.58], p = .6). In analysis 2, surge was associated with an increased odds of death (odds ratio 1.39 [95% CI, 1.34-1.43], p < .001). CONCLUSIONS: Admission to an ICU with COVID-19 in a hospital that is experiencing surge conditions may be associated with an increased odds of death. Given the high incidence of COVID-19, such increases would translate into substantial excess mortality.