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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
* Equal first authors.
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.
- Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA 2020; 323: 1574-81.
- Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708-20.
- Myers LC, Parodi SM, Escobar GJ, Liu VX. Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California. JAMA 2020; 323: 2195-8.
- Young BE, Ong SWX, Kalimuddin S, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA 2020; 323: 1488-94.
- Salje H, Tran Kiem C, Lefrancq N, et al. Estimating the burden of SARS-CoV-2 in France. Science 2020; 369: 208-11.
- Arentz M, Yim E, Klaff L, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA 2020; 323: 1612-4.
- Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020; 323: 2052-9.
- Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8: 475-81.
- Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. Vital surveillances: the epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) — China, 2020. China CDC Weekly 2020; 8: 113-22. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51 (viewed Sept 2020).
- Auld SC, Caridi-Scheible M, Blum JM, et al. ICU and ventilator mortality among critically ill adults with coronavirus disease 2019. Crit Care Med 2020; doi: 10.1097/CCM.0000000000004457 [Epub ahead of print].
- Zangrillo A, Beretta L, Scandroglio AM, et al. Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy. Crit Care Resusc 2020; 22: 200-11.
- Wang K, Zhang Z, Yu M, et al. 15-day mortality and associated risk factors for hospitalized patients with COVID-19 in Wuhan, China: an ambispective observational cohort study. Intensive Care Med 2020; 46: 1472-4.
- Wang Y, Lu X, Li Y, et al. Clinical course and outcomes of 344 intensive care patients with COVID-19. Am J Respir Crit Care Med 2020; 201: 1430-4.
- Swedish National Quality Registries. http://www.kvalitetsregister.se/englishpages.2040.html (viewed Aug 2020).
- Public Health Agency of Sweden. [Number of COVID-19 cases in Sweden (website)]. [Swedish] https://experience.arcgis.com/experience/09f821667ce64bf7be6f9f87457ed9aa (viewed Aug 2020).
- National Board of Health and Welfare. [Statistics on inpatient care for patients with COVID-19 (website)]. [Swedish] https://www.socialstyrelsen.se/statistik-och-data/statistik/statistik-om-covid-19/statistik-om-slutenvard-av-patienter-med-covid-19/ (viewed Aug 2020).
- Armstrong RA, Kane AD, Cook TM. Outcomes from intensive care in patients with COVID-19: a systematic review and meta-analysis of observational studies. Anaesthesia 2020; doi: 10.1111/anae.15201 [Epub ahead of print].
- Liang W, Liang H, Ou L, et al. Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19. JAMA Intern Med 2020; 180: 1-9.
- Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020; 180: 1-11.
- Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054-62.
https://doi.org/10.51893/2020.4.OA3 (in process of being registered 7/7/2021)