TY - JOUR
T1 - Non-COVID-19 intensive care admissions during the pandemic
T2 - a multinational registry-based study
AU - McLarty, Joshua
AU - Litton, Edward
AU - Beane, Abigail
AU - Aryal, Diptesh
AU - Bailey, Michael
AU - Bendel, Stepani
AU - Burghi, Gaston
AU - Christensen, Steffen
AU - Christiansen, Christian Fynbo
AU - Dongelmans, Dave A
AU - Fernandez, Ariel L
AU - Ghose, Aniruddha
AU - Hall, Ros
AU - Haniffa, Rashan
AU - Hashmi, Madiha
AU - Hashimoto, Satoru
AU - Ichihara, Nao
AU - Kumar Tirupakuzhi Vijayaraghavan, Bharath
AU - Lone, Nazir I
AU - Arias López, Maria Del Pilar
AU - Mat Nor, Mohamed Basri
AU - Okamoto, Hiroshi
AU - Priyadarshani, Dilanthi
AU - Reinikainen, Matti
AU - Soares, Marcio
AU - Pilcher, David
AU - Salluh, Jorge
AU - Linking of Global Intensive Care (LOGIC) Collaboration
PY - 2024/1
Y1 - 2024/1
N2 - BACKGROUND: The COVID-19 pandemic resulted in a large number of critical care admissions. While national reports have described the outcomes of patients with COVID-19, there is limited international data of the pandemic impact on non-COVID-19 patients requiring intensive care treatment.METHODS: We conducted an international, retrospective cohort study using 2019 and 2020 data from 11 national clinical quality registries covering 15 countries. Non-COVID-19 admissions in 2020 were compared with all admissions in 2019, prepandemic. The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included in-hospital mortality and standardised mortality ratio (SMR). Analyses were stratified by the country income level(s) of each registry.FINDINGS: Among 1 642 632 non-COVID-19 admissions, there was an increase in ICU mortality between 2019 (9.3%) and 2020 (10.4%), OR=1.15 (95% CI 1.14 to 1.17, p<0.001). Increased mortality was observed in middle-income countries (OR 1.25 95% CI 1.23 to 1.26), while mortality decreased in high-income countries (OR=0.96 95% CI 0.94 to 0.98). Hospital mortality and SMR trends for each registry were consistent with the observed ICU mortality findings. The burden of COVID-19 was highly variable, with COVID-19 ICU patient-days per bed ranging from 0.4 to 81.6 between registries. This alone did not explain the observed non-COVID-19 mortality changes.INTERPRETATION: Increased ICU mortality occurred among non-COVID-19 patients during the pandemic, driven by increased mortality in middle-income countries, while mortality decreased in high-income countries. The causes for this inequity are likely multi-factorial, but healthcare spending, policy pandemic responses, and ICU strain may play significant roles.
AB - BACKGROUND: The COVID-19 pandemic resulted in a large number of critical care admissions. While national reports have described the outcomes of patients with COVID-19, there is limited international data of the pandemic impact on non-COVID-19 patients requiring intensive care treatment.METHODS: We conducted an international, retrospective cohort study using 2019 and 2020 data from 11 national clinical quality registries covering 15 countries. Non-COVID-19 admissions in 2020 were compared with all admissions in 2019, prepandemic. The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included in-hospital mortality and standardised mortality ratio (SMR). Analyses were stratified by the country income level(s) of each registry.FINDINGS: Among 1 642 632 non-COVID-19 admissions, there was an increase in ICU mortality between 2019 (9.3%) and 2020 (10.4%), OR=1.15 (95% CI 1.14 to 1.17, p<0.001). Increased mortality was observed in middle-income countries (OR 1.25 95% CI 1.23 to 1.26), while mortality decreased in high-income countries (OR=0.96 95% CI 0.94 to 0.98). Hospital mortality and SMR trends for each registry were consistent with the observed ICU mortality findings. The burden of COVID-19 was highly variable, with COVID-19 ICU patient-days per bed ranging from 0.4 to 81.6 between registries. This alone did not explain the observed non-COVID-19 mortality changes.INTERPRETATION: Increased ICU mortality occurred among non-COVID-19 patients during the pandemic, driven by increased mortality in middle-income countries, while mortality decreased in high-income countries. The causes for this inequity are likely multi-factorial, but healthcare spending, policy pandemic responses, and ICU strain may play significant roles.
KW - COVID-19
KW - Clinical Epidemiology
KW - Critical Care
KW - Critical Care/methods
KW - Intensive Care Units
KW - COVID-19/epidemiology
KW - Pandemics
KW - Humans
KW - Registries
KW - Retrospective Studies
UR - http://www.scopus.com/inward/record.url?scp=85164397407&partnerID=8YFLogxK
U2 - 10.1136/thorax-2022-219592
DO - 10.1136/thorax-2022-219592
M3 - Journal article
C2 - 37225417
SN - 0040-6376
VL - 79
SP - 120
EP - 127
JO - Thorax
JF - Thorax
IS - 2
M1 - thorax-2022-219592
ER -