Abstract
BackgroundThe early months of the COVID-19 pandemic were fraught with much uncertainty and some resource constraint. We assessed the change in survival to hospital discharge over time for intensive care unit patients with COVID-19 during the first 3 months of the pandemic and the presence of any surge effects on patient outcomes.MethodsRetrospective cohort study using electronic medical record data for all patients with laboratory-confirmed COVID-19 admitted to intensive care units from February 25, 2020, to May 15, 2020, at one of 26 hospitals within an integrated delivery system in the Western USA. Patient demographics, comorbidities, and severity of illness were measured along with medical therapies and hospital outcomes over time. Multivariable logistic regression models were constructed to assess temporal changes in survival to hospital discharge during the study period.ResultsOf 620 patients with COVID-19 admitted to the ICU [mean age 63.5 years (SD 15.7) and 69% male], 403 (65%) survived to hospital discharge and 217 (35%) died in the hospital. Survival to hospital discharge increased over time, from 60.0% in the first 2 weeks of the study period to 67.6% in the last 2 weeks. In a multivariable logistic regression analysis, the risk-adjusted odds of survival to hospital discharge increased over time (biweekly change, adjusted odds ratio [aOR] 1.22, 95% CI 1.04–1.40, P = 0.02). Additionally, an a priori-defined explanatory model showed that after adjusting for both hospital occupancy and percent hospital capacity by COVID-19-positive individuals and persons under investigation (PUI), the temporal trend in risk-adjusted patient survival to hospital discharge remained the same (biweekly change, aOR 1.18, 95% CI 1.00–1.38, P = 0.04). The presence of greater rates of COVID-19 positive/PUI as a percentage of hospital capacity was, however, significantly and inversely associated with survival to hospital discharge (aOR 0.95, 95% CI 0.92–0.98, P < 0.01).ConclusionsDuring the early COVID-19 pandemic, risk-adjusted survival to hospital discharge increased over time for critical care patients. An association was also seen between a greater COVID-19-positive/PUI percentage of hospital capacity and a lower survival rate to hospital discharge.
Highlights
The early months of the COVID-19 pandemic were fraught with much uncertainty and some resource constraint
The coronavirus 2019 (COVID-19) global pandemic caused by SARS-CoV-2 has posed significant challenges to intensive care units (ICUs) across the world
Description of the study cohort Patients During the study period, 650 patients with COVID-19 were admitted: 13 (2.0%) patients were excluded for subsequent readmissions and 17 (2.7%) were excluded for continued hospitalization at the end of the data collection period
Summary
The early months of the COVID-19 pandemic were fraught with much uncertainty and some resource constraint. We assessed the change in survival to hospital discharge over time for intensive care unit patients with COVID-19 during the first 3 months of the pandemic and the presence of any surge effects on patient outcomes. The coronavirus 2019 (COVID-19) global pandemic caused by SARS-CoV-2 has posed significant challenges to intensive care units (ICUs) across the world. During the early months of the COVID-19 pandemic in the USA and Europe, many organizations treated “surges” of patients during a time of incomplete understanding of critical illness related to SARS-CoV-2 and a lack of clearly effective COVID-19-specific therapies. In addition to the ambiguous and evolving clinical situation, resource constraints, rationing in some areas of the world and discussions of crisis care standards, may have each contributed to adverse patient outcomes [13,14,15]. Some studies were able to demonstrate improved survival to hospital discharge during this early period [16, 17]
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