Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US
MD, MPH Shruti Gupta, MD Salim S Hayek, PhD Wei Wang, MD Lili Chan, MSCR Kusum S Mathews, MD, MPH, MSCR Michal L Melamed, MD, MHS Samantha K Brenner, MD, MPH Amanda Leonberg-Yoo, MS Edward J Schenck, MD, MS Jared Radbel, MD Jochen Reiser, PhD Anip Bansal, MD Anand Srivastava, MD, MPH Yan Zhou, MD Anne Sutherland, MD Adam Green, MD, MBA; Alexandre M Shehata, MD Nitender Goyal, MD Anitha Vijayan, Juan Carlos Q Velez, MD, MPH Shahzad Shaefi, MD, PhD Chirag R Parikh, MD Justin Arunthamakun, MBBS Ambarish M Athavale, MD Allon N Friedman, MD Samuel A P Short, BA Zoe A Kibbelaar, Samah Abu Omar, MD, MPH, MSc; Andrew J Admon, PhD John P Donnelly, MD Hayley B Gershengorn, MD, DrPH Miguel A Hernán, MD Matthew W Semler, MD, MMSc; 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 Hart, Oyintayo Ajiboye, Matthew Itteera, Jean-Sebastien Rachoin, Christa A Schorr, Lisa Shea, Daniel L 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 A 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, H Byrant Nguyen, Afshin Ahoubim, Leslie F Thomas, Dheeraj Reddy Sirganagari, Pramod K Guru, Paul A Bergl, Jesus Rodriguez, Jatan A Shah, Mrigank S Gupta, Princy N Kumar, Deepa G Lazarous, Seble G 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 L Alvarez-Mulett, Luis G Gomez-Escobar, Di Pan, Stefi Lee, Jamuna Kirshnan, William Whalen, David Charytan, Ashley Macina, Daniel W Ross, Alexander S Leidner, Carlos Martinez, Jacqueline M Kruser, Richard G Wunderink, Alexander J Hodakowski, Eboni G Price-Haywood, Luis A Matute-Trochez, Anne E Hasty, Muner Mb 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, Jeffery O Boateng, Meghan Lee, Ian A Strohbehn, Jiahua Li, Saif A Muhsin, Ernest I Mandel, Ariel L Mueller, Nicholas S Cairl, Chris Rowan, Farah Madhai-Lovely, Vasil Peev, John J Byun, Andrew Vissing, Esha M Kapania, Zoe Post, Nilam P Patel, Joy-Marie Hermes, Amee Patrawalla, Diana G Finkel, Barbara A Danek, Sowminya Arikapudi, Jeffery M Paer, Sonika Puri, Jag Sunderram, Matthew T Scharf, Ayesha Ahmed, Ilya Berim, Sabiha Hussain, Shuchi Anand, Joseph E Levitt, Pablo Garcia, 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 Tolwani, Timothy E Albertson, Jason Y Adams, Steven Y Chang, Rebecca M Beutler, Carl E Schulze, Etienne Macedo, Harin Rhee, Kathleen D Liu, Vasantha K 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 J Padalia, Abbas Bitar, Jennifer E Flythe, Matthew J Tugman, Brent R Brown, Ryan C Spiardi, Todd A Miano, Meaghan S Roche, Charles R Vasquez, Amar D Bansal, Natalie C Ernecoff, Csaba P Kovesdy, Miklos Z Molnar, Ambreen Azhar, Susan S Hedayati, Mridula V Nadamuni, Sadaf S Khan, Duwayne L Willett, Amanda D Renaghan, Pavan K Bhatraju, Bilal A Malik, Christina Mariyam Joy, Tingting Li, Seth Goldberg, Patricia F Kao, Greg L Schumaker, Anthony J Faugno, Caroline M Hsu, Asma Tariq, Leah Meyer, Daniel E Weiner
JAMA Internal Medicine, doi:10.1001/jamainternmed.2020.3596
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 (Ն80 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 (Ն40 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 Ն300 mm Hg: OR, 2.94; 95% CI, 2.11-4.08), liver dysfunction (liver Sequential Organ Failure Assessment score of 2 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 Ն100 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.
Author Contributions: Drs Gupta and Leaf had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
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