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COVID-19 critical illness in Sweden: characteristics and outcomes at a national population level
Johan Mårtensson*, Lars Engerström*, Sten Walther, Jonathan Grip, Ritva Kiiski Berggren, Emma Larsson, (* Equal first authors)
Crit Care Resusc 2020; 22 (4): 312-320
- Johan Mårtensson* 1, 2
- Lars Engerström* 3, 4, 5
- Sten Walther 3, 4, 6
- Jonathan Grip 2, 7
- Ritva Kiiski Berggren 5, 8
- Emma Larsson 1, 2, 5
- (* Equal first authors) 9
OBJECTIVE: During the coronavirus disease 2019 (COVID-19) pandemic, baseline demographics and comorbidities of patients with COVID-19 have been presented, but there are limited data on outcomes of severely ill patients. We aimed to examine the association between patient characteristics and 30-day mortality among patients with COVID-19 treated in the intensive care unit (ICU).
DESIGN: Population-based cohort study.
SETTING: ICUs in Sweden. Participants: All consecutive patients with COVID-19 admitted to Swedish ICUs from 6 March to 5 April 2020. Main outcome measures: The primary outcome was 30day mortality after ICU admission. Patient demographics, comorbidities and clinical characteristics were also retrieved.
RESULTS: A total of 604 patients were included. The median age was 61 years (interquartile range [IQR], 52–70 years) and 458 patients (76%) were males. The most common comorbidities were hypertension (35.9%) and diabetes (25.7%), whereas 36.4% of patients had no comorbidities. Median Simplified Acute Physiology Score (SAPS) 3 was 53 (IQR, 46–60). Of 573 patients with available respiratory support data, 487 (85.0%) received invasive mechanical ventilation. Among 518 patients with available data, 117 (22.6%) received renal replacement therapy. Median length of stay was 13 days (IQR, 6–20 days). Mortality at 30 days was 32.6%. In the multivariable Cox regression model, age (hazard ratio [HR] 1.06; 95% CI, 1.04–1.07 per year), the presence of one or more comorbidities (HR, 1.80; 95% CI, 1.20–2.68), chronic obstructive pulmonary disease or asthma (HR, 1.68; 95% CI, 1.12–2.50), hypertension (HR, 1.41; 95% CI, 1.01–1.99), and acute illness severity (SAPS 3 excluding age and comorbidity) (HR, 1.06; 95% CI, 1.04– 1.09) were associated with 30-day mortality.
CONCLUSIONS: This population-based cohort study presents 30-day mortality of 604 ICU patients with COVID-19. The higher mortality was explained by older age, the presence chronic illness, and acute illness severity.
Funding/Source of Funding
The study received sponsorship from the Knut and Alice Wallenberg Foundation.
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https://doi.org/10.51893/2020.4.OA3 (in process of being registered 7/7/2021)