Outcomes of Patients With Coronavirus Disease 2019 Receiving Organ Support Therapies: The International Viral Infection and Respiratory Illness Universal Study Registry.

To describe the outcomes of hospitalized patients in a multicenter, international coronavirus disease 2019 registry. Cross-sectional observational study including coronavirus disease 2019 patients hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection between February 15, 2020, and November 30, 2020, according to age and type of organ support therapies. About 168 hospitals in 16 countries within the Society of Critical Care Medicine's Discovery Viral Infection and Respiratory Illness University Study coronavirus disease 2019 registry. Adult hospitalized coronavirus disease 2019 patients who did and did not require various types and combinations of organ support (mechanical ventilation, renal replacement therapy, vasopressors, and extracorporeal membrane oxygenation). None. Primary outcome was hospital mortality. Secondary outcomes were discharge home with or without assistance and hospital length of stay. Risk-adjusted variation in hospital mortality for patients receiving invasive mechanical ventilation was assessed by using multilevel models with hospitals as a random effect, adjusted for age, race/ethnicity, sex, and comorbidities. Among 20,608 patients with coronavirus disease 2019, the mean (± sd) age was 60.5 (±17), 11,1887 (54.3%) were men, 8,745 (42.4%) were admitted to the ICU, and 3,906 (19%) died in the hospital. Hospital mortality was 8.2% for patients receiving no organ support (n = 15,001). The most common organ support therapy was invasive mechanical ventilation (n = 5,005; 24.3%), with a hospital mortality of 49.8%. Mortality ranged from 40.8% among patients receiving only invasive mechanical ventilation (n =1,749) to 71.6% for patients receiving invasive mechanical ventilation, vasoactive drugs, and new renal replacement therapy (n = 655). Mortality was 39% for patients receiving extracorporeal membrane oxygenation (n = 389). Rates of discharge home ranged from 73.5% for patients who did not require organ support therapies to 29.8% for patients who only received invasive mechanical ventilation, and 8.8% for invasive mechanical ventilation, vasoactive drugs, and renal replacement; 10.8% of patients older than 74 years who received invasive mechanical ventilation were discharged home. Median hospital length of stay for patients on mechanical ventilation was 17.1 days (9.7-28 d). Adjusted interhospital variation in mortality among patients receiving invasive mechanical ventilation was large (median odds ratio 1.69). Coronavirus disease 2019 prognosis varies by age and level of organ support. Interhospital variation in mortality of mechanically ventilated patients was not explained by patient characteristics and requires further evaluation.

Informations de copyright

Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Déclaration de conflit d'intérêts

Drs. Kumar’s, Denson’s, Walkey’s, and Kashyap’s institutions received funding from the Gordon and Betty Moore Foundation. Drs. Kumar’s and Kashyap’s institutions received funding from Janssen Research & Development, LLC. Drs. Kaufman’s and Denson’s institutions received funding from the Society of Critical Care Medicine. Dr. Banner-Goodspeed received partial salary support through her home institution from multiple federal research grants (including from the National Institutes of Health [NIH] and Department of Defense) as key personnel, not the principal investigator. Dr. Anderson III disclosed he is an Advisory Board member for Gift of Life Michigan. Dr. Denson received other support from American Diabetes Association Grant #7-20-COVID-53. Dr. Gajic received support for article research from Gordon and Betty Moore Foundation. Dr. Walkey receives funding from the NIH/National Heart, Lung and Blood Institute grants R01HL151607, R01HL139751, and R01HL136660, Agency of Healthcare Research and Quality, R01HS026485, Boston Biomedical Innovation Center/NIH/NHLBI 5U54HL119145-07, and royalties from UptoDate. They had no influence on acquisition, analysis, interpretation, and reporting of pooled data for this article. Dr. Harhay’s institution receives funding from the NIH/National Heart, Lung and Blood Institute grant R00 HL141678, and he received support for article research from the NIH. They had no influence on acquisition, analysis, interpretation, and reporting of pooled data for this article. Dr. Gajic receives funding from the Agency of Healthcare Research and Quality R18HS 26609-2, NIH/National Heart, Lung and Blood Institute: R01HL 130881 and UG3/UH3HL 141722; Department of Defense W81XWH; American Heart Association Rapid Response Grant—coronavirus disease 2019 (COVID-19); and royalties from Ambient Clinical Analytics. They had no influence on acquisition, analysis, interpretation, and reporting of pooled data for this article. Dr. Kashyap receives funding from the NIH/National Heart, Lung and Blood Institute: R01HL 130881 and UG3/UH3HL 141722; Gordon and Betty Moore Foundation, and Janssen Research & Development, LLC; and royalties from Ambient Clinical Analytics. They had no influence on acquisition, analysis, interpretation, and reporting of pooled data for this article. Dr. St. Hill receives funding from the Minnesota Department of Health. They had no influence on acquisition, analysis, interpretation, and reporting of pooled data for this article. Dr. Denson receives funding for COVID-19 research from the American Diabetes Association grant #7-20-COVID-053, Centers for Disease Control and Prevention BroadAgency Announcement 75D301-20-R-67897, and National Institute of General Medical Sciences/NIH award U54 GM104940, which funds the Louisiana Clinical and Translational Science Center. They had no influence on acquisition, analysis, interpretation, and reporting of pooled data for this article. Dr. Martin receives funding from the Biomedical Advanced Research and Development Authority and NIH through the National Institute of Biomedical Imaging and Bioengineering U54 EB-027690, the National Heart, Lung and Blood Institute: U54 HL-143541-02S2, the National Institute for General Medical Sciences R01 GM-104323, and the Office of the Director OT2 OD-026551; as well as funding from Genentech for clinical trial monitoring. They had no influence on acquisition, analysis, interpretation, and reporting of pooled data for this article. The remaining authors have disclosed that they do not have any potential conflicts of interest.