Outcomes From Intensive Care in COVID-19 Patients

Quick Takes

  • The mortality of patients with COVID-19 admitted to the ICU is reportedly high, but the current literature contains small case series and cohort studies.
  • This systematic review and meta-analysis identified 24 observational studies including 10,150 patients from centers across Asia, Europe, and North America, and demonstrated an ICU mortality rate in those with a completed ICU stay of 41.6% (95% CI, 34.0%-49.7%; I2 = 93.2%).
  • The mortality is broadly consistent across the world; as the pandemic has progressed, reported ICU mortality rates have reduced from >50% in March 2020 to close to 40% at the end of May 2020.

Study Questions:

What is the mortality occurring within intensive care units (ICUs) among patients admitted with coronavirus disease 2019 (COVID-19) (where there is a definitive outcome, i.e., either died or discharged alive from the ICU)?

Methods:

The authors performed a systematic review and meta-analysis, in line with PRISMA guidelines, to assess the reported ICU mortality for patients with confirmed COVID-19. The authors searched MEDLINE, EMBASE, PubMed, and Cochrane databases up to May 31, 2020 for studies reporting ICU mortality for adult patients admitted with COVID-19. The primary outcome measure was death in intensive care as a proportion of completed ICU admissions, either through discharge from the ICU or death. The definition thus did not include patients still alive in the ICU.

Results:

Twenty-four observational studies including 10,150 patients were identified from centers across Asia, Europe, and North America. In-ICU mortality in reported studies ranged from 0 to 84.6%. Seven studies reported outcome data for all patients. In the remaining studies, the proportion of patients discharged from the ICU at the point of reporting varied from 24.5% to 97.2%. In patients with completed ICU admissions with COVID-19 infection, combined ICU mortality was 41.6% (95% confidence interval [CI], 34.0%-49.7%; I2 = 93.2%). Subgroup analyses by geographic location and study characteristics (including single or multiple centers, sample size, complete outcome reporting) showed no significant between-group differences or substantial reduction in heterogeneity. The in-ICU mortality from COVID-19 is higher than usually seen in ICU admissions with other viral pneumonias.

Conclusions:

This systematic review and meta-analysis of ICU outcome in patients with COVID-19 found an in-ICU mortality rate of 41.6% across international studies. The authors further concluded that there were no significant effects of geographical location, but reported ICU mortality fell over time.

Perspective:

To the best of our knowledge, this is among the first systematic reviews and meta-analyses of outcomes of COVID-19 patients admitted to the ICU. Importantly, it included 10,150 patients from centers across Asia, Europe, and North America, and demonstrated an ICU mortality rate in those with a completed ICU stay of 41.6% (95% CI, 34.0%-49.7%). The high degree of heterogeneity (I2 = 93.2%) in the meta-analysis, with only 24 observational studies (several with small numbers of patients), suggests that survival rates between studies are highly variable. Thus, these results should be interpreted with caution. Further limitations, as the authors appropriately acknowledge, include the high heterogeneity of reported outcomes, the lack of data from several countries, and deviations from the published protocol in PROSPERO. From a research perspective, this serves as a call to action to collect and report outcome data in a more systematic fashion.

Clinical Topics: Prevention

Keywords: Coronavirus, COVID-19, Critical Care, Intensive Care Units, Outcome Assessment (Health Care), Patient Discharge, Pneumonia, Viral, Primary Prevention, severe acute respiratory syndrome coronavirus 2, Survival Rate


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