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Characteristics, Outcomes, and Trends of Patients With COVID-19-Related Critical Illness at a Learning Health System in the United States.
- Source :
-
Annals of Internal Medicine . 5/18/2021, Vol. 174 Issue 5, p613-621. 9p. 1 Diagram, 3 Charts, 2 Graphs. - Publication Year :
- 2021
-
Abstract
- <bold>Background: </bold>The coronavirus disease 2019 (COVID-19) pandemic continues to surge in the United States and globally.<bold>Objective: </bold>To describe the epidemiology of COVID-19-related critical illness, including trends in outcomes and care delivery.<bold>Design: </bold>Single-health system, multihospital retrospective cohort study.<bold>Setting: </bold>5 hospitals within the University of Pennsylvania Health System.<bold>Patients: </bold>Adults with COVID-19-related critical illness who were admitted to an intensive care unit (ICU) with acute respiratory failure or shock during the initial surge of the pandemic.<bold>Measurements: </bold>The primary exposure for outcomes and care delivery trend analyses was longitudinal time during the pandemic. The primary outcome was all-cause 28-day in-hospital mortality. Secondary outcomes were all-cause death at any time, receipt of mechanical ventilation (MV), and readmissions.<bold>Results: </bold>Among 468 patients with COVID-19-related critical illness, 319 (68.2%) were treated with MV and 121 (25.9%) with vasopressors. Outcomes were notable for an all-cause 28-day in-hospital mortality rate of 29.9%, a median ICU stay of 8 days (interquartile range [IQR], 3 to 17 days), a median hospital stay of 13 days (IQR, 7 to 25 days), and an all-cause 30-day readmission rate (among nonhospice survivors) of 10.8%. Mortality decreased over time, from 43.5% (95% CI, 31.3% to 53.8%) to 19.2% (CI, 11.6% to 26.7%) between the first and last 15-day periods in the core adjusted model, whereas patient acuity and other factors did not change.<bold>Limitations: </bold>Single-health system study; use of, or highly dynamic trends in, other clinical interventions were not evaluated, nor were complications.<bold>Conclusion: </bold>Among patients with COVID-19-related critical illness admitted to ICUs of a learning health system in the United States, mortality seemed to decrease over time despite stable patient characteristics. Further studies are necessary to confirm this result and to investigate causal mechanisms.<bold>Primary Funding Source: </bold>Agency for Healthcare Research and Quality. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 00034819
- Volume :
- 174
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- Annals of Internal Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 150513804
- Full Text :
- https://doi.org/10.7326/M20-5327