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JAMA Network Open | December 22, 2021 | Volume: 4 | Issue: 12 | Pages: e2140568
Outcomes of Patients With Coronavirus Disease 2019 Receiving Organ Support Therapies: The International Viral Infection and Respiratory Illness Universal Study Registry
Domecq, Juan Pablo , Lal, Amos , Sheldrick, Christopher R., Kumar, Vishakha K. , Boman, Karen , Bolesta, Scott , Bansal, Vikas , Garcia, Michael A. , Kaufman, Margit, Danesh, Valerie , Anderson, Harry L., Milligan, Patrick S., Denson, Joshua L. , Hill, Catherine A. St., Dodd, Kenneth W. , Gajić, Ognjen, Kashyap, Rahul , Tierney, David M. , Camazine, Maraya , Dapul, Heda , Gharpure, Varsha , Koritala, Thoyaja , Заболотских, И. Б. , Kovačević, Peđja , Asghar, Muhammad Sohaib , McGonagill, Patrick W. , El‐Kassas, Mohamed , Parameswaran, Sreejith , Iwasaki, Yudai , Nenadić, Irina , Djuric, Marko , Lutrick, Karen , Lumelsky, David , Minear, Steven , Tarabichi, Yasir , Dy, Rajany , Galet, Colette , West, T. Eoin , Wilfong, Erin M. , Ramírez, Michelle , Law, Anica C. , Lal, Amos , Bansal, Vikas , Denson, Joshua L , Kashyap, Rahul , Gharpure, Varsha P , Asghar, Muhammad S , Domecq Graces, Juan Pablo , Sheldrick, Christopher R., Harhay, Michael Oscar , Cheruku, Sreekanth , Banner‐Goodspeed, Valerie , Anderson, Harry L., Martin, Greg S. , Gajic, Ognjen , Walkey, Allan J.
Critical Care Medicine | January 29, 2021 | Volume: 49 | Issue: 3 | Pages: 437-448
OBJECTIVES: To describe the outcomes of hospitalized patients in a multicenter, international coronavirus disease 2019 registry. DESIGN: 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. SETTING: 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. PATIENTS: 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). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 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). CONCLUSIONS: 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.